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Medicine’s next big thing: No more pain pills?

By dsorbello at March 16, 2010, 11:19 a.m., 15550 hits

Pain control after surgery is a top priority of both doctors and patients. Methods of controlling post-surgical pain vary on a patient's needs and type of procedure, but all treatments administered in the hospital are relatively safe. Dangerous side effects are rare, but nausea, vomiting, itching and drowsiness are common, especially from opiod (narcotic) medications like morphine, fentanyl and hydromorphone.

Opioids like morphine, codeine and related drugs like oxycodone (OxyContin), hydrocodone (Vicodin) and meperidine (Demerol) are commonly prescribed to relieve chronic pain or pain following surgery, but they can cause drowsiness, and in higher doses, depressed respiration. Opioids can also cause euphoria in some patients and, if used long-term, tolerance.

Tolerance means a person has to take higher and higher doses to achieve the same effects. Tolerance can eventually lead to physical dependence and addiction. According to the National Institute on Drug Abuse, those addicted to opioid medications are more likely to overdose, which can be fatal. Withdrawal symptoms of opioid addiction include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes and involuntary leg movements.

Officials at the Cleveland Clinic said the risk of developing an addiction to pain medication after surgery is very small, and that a bigger risk is posed by a prolonged recovery if pain medications are avoided. A panel of experts recently stated that opioids are actually a better choice than aspirin or ibuprofen for those 75 or older.

A panel of experts concluded that the high doses of non-steroidal anti-inflammatory drugs (NSAIDS), which include aspirin and ibuprofen, necessary to control pain in some older patients are more dangerous than opioid medications. New pain management guidelines issued by the American Geriatric Society removed NSAIDS from the list of drugs recommended for frail elderly adults with persistent pain.

Researchers at Children's Hospital Boston have developed an anesthetic drug delivery system that could make a huge impact on pain management and help patients avoid potentially addictive oral pain medications. They packaged the anesthetic saxitoxin in fat-based particles called liposomes.

The result was a long-lasting, local anesthesia that had no apparent toxicity to nerve or muscles cells in rats. Previous attempts at similar drugs have not been successful because of the tendency of conventional anesthetics to damage surrounding tissue.

In the study, the best liposomes produced nerve blocks that lasted two days if they contained saxitoxin alone and seven days if combined with dexamethasone. Researchers are working to make the formulation last longer.

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