Millions of people who suffer from chronic pain take opioid drugs that carry significant risks of addiction and can often do more harm than good. But scientists are developing a new generation of solutions to deal with the problem in ways that safer and more effective than medication, a top expert says.
“The future is promising in the rapidly evolving field of chronic pain management. As we move away from the antiquated, higher risk therapies that only mask the problem, emerging therapies that more precisely target the pain generator are on the horizon,” Dr. Matthew Crooks tells Newsmax Health.
The nation is in the midst of a crisis when it comes to opioid overuse and dependence, the Centers for Disease Control and Prevention (CDC) says. In 2014 alone, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record, the CDC says.
A new report by the U.S. Drug Enforcement Administration also noted noted that U.S. deaths tied to heroin use have tripled over the last decade, while deaths from prescription painkillers have nearly doubled since 2013.
Common legal opioids include Percocet and Vicodin, but also fentanyl, an extremely powerful opioid, which was blamed for death of the legendary singer Prince. Such drugs can often be the gateway to more elicit drugs, including heroin, as users build up a tolerance and become reliant on opioids, law enforcement and medical experts say.
“What we at the forefront of the pain management specialty have know for years about opioids is now becoming public knowledge: in many cases, the cure is worse than the disease,” says Crooks, a board-certified pain management expert in Scottsdale, Ariz.
But while the CDC has issued new prescription guidelines aimed at curbing the overuse of opioids for problems such as back pain and arthritis, these recommendations did not extend to severe pain, including that from cancer, which is a very serious problem, says Crooks.
1. TENS — Transcutaneous electrical nerve stimulation (TENS) is a current therapy that uses low-voltage electrical current for pain relief. This procedure uses a small, battery-powered device, which is attached using electrodes to the skin. The electrodes are often placed on the area of pain or at a pressure point, creating a circuit of electrical impulses that travels along nerve fibers. When the current is delivered, some people experience less pain.
Researchers at the University of Texas in Arlington are taking electrical stimulation to the next level. They have developed an implantable wireless device that stimulates a deep, middle-brain structure that blocks pain signals at the spinal cord level without drug intervention. The device, which is still experimental, also triggers the release of beneficial dopamine, which may reduce the emotional distress associated with long-term pain.
“This is the first study to use a wireless electrical device to alleviate pain by directly stimulating the ventral tegmental area of the brain,” says researcher Yuan Bo Peng. While still under laboratory testing, this new method does provide hope that in the future we will be able to alleviate chronic pain without the side effects of medication,” he adds.
2. Platelet-rich plasma — PRP uses blood taken from a patient, which is then treated to create a concentration of platelets that are injected into the site of pain or used to speed healing after surgery. The technique has primarily been used by high profile athletes, such Tiger Woods, Kobe Bryant, Rafael Nadal and, most recently, Golden State Warrior Stephen Curry, who recently underwent treatments to try and help his knee heal faster after an MCL sprain. The procedure is still being investigated for effectiveness, but it is becoming increasingly becoming mainstream, as doctors use it to help delay hip surgeries in patients.
3. Stem cell treatments — The use of stem cells to treat pain differs from the various uses currently under investigation to cure diseases. Unlike these procedures, which may use stem cells taken from other sources, the pain-therapy experiments use stem cells harvested from a patient’s own bone marrow. Although the research has only recently begun, the preliminary results are promising.
4. Neurostimulation — In this procedure, a stimulator is implanted under the skin and then an electrical impulse is delivered to the spine that overrides a painful nerve signal and scrambles it to make it feel like a comfortable sensation. “This is something that we’re doing now in people that have refractory nerve problems, such as those who have had a limb removed, but this procedure is improving, so that patients that didn’t find it comfortable before are now liking it better,” says Crooks.
5. Minimally invasive surgery — Spine surgery is traditionally done as open surgery, meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the spine. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique. These procedures are being done using small instruments, such as endoscopes, and such equipment is becoming smaller and smaller, and hence, less invasive. “I tell any patient to wait a year or two as long as it is not an urgent problem. This is because the technology is starting to advance so rapidly that the surgery will be so much less invasive then, you’ll recover faster,” says Crooks.
6. Nanotechnology — This is the future of minimally invasive surgery, says Crooks. He envisions a day when instruments could become so tiny, even sub-molecular – so a patient could ingest or swallow them, and then they could potentially target an area that isn’t even problematic yet. “We’re in era where you can sequence a person’s genes. So if your mother or father had a hip replacement at a young age, and it’s found that you’re predisposed to it, there may be an opportunity to deal with it before it becomes a problem,” says Crooks.
7. Physical rehabilitation — Rehab has long been around but now it is being integrated with the services of pain management doctors, and this is changing the field and making it much more effective for people with chronic pain. “These exciting therapies in the future will be used in combination with tried-and-true methods of physical conditioning and rehabilitation, so the goal will be to build strength, utilize biomechanics to restore function, and resolve the underlying problem,” says Crooks.