Tuesday, 1 February 2011

A Cure for Pain?

Last night's Horizon programme, The Secret World of Pain, was absolutely fascinating and in parts, if you're a spoonie like me, thrilling. I recommend anyone living with pain to watch it on iplayer.

I've watched a lot of medical documentaries. I've read medical journals, and scientific theories and most are as far from ever becoming viable treatments as marmalade bandages. Last night, however, I learnt a few really, really encouraging things.

The programme introduced a family in Italy who don't feel pain. Over three generations (proving a genetic link) the family either don't experience pain, or don't feel certain types of pain. In the UK, there was a woman who simply felt no pain at all. By studying these incredibly rare people, scientists had made a genuinely extraordinary discovery. Whilst pain is a ridiculously complicated process involving hundreds of neurons and genes, only one gene actually controls how we feel pain. Scientists have isolated this gene - the SCN9A gene - and found it mutated in all of people they were studying. In every other way they were normal, unaffected. This leads scientists to suggest that if a drug could be developed that blocked the SCN9A gene, it would be the perfect painkiller with no side effects.


Although the whole programme was fascinating, the other research that I found extraordinary was being done by the Pain Relief Foundation in Liverpool. Using thousands of brain images, scientists seem to have discovered that constant, chronic, pain does actually cause damage in the brain. The primary motor cortex comes under enormous pressure from the endless onslaught of pain messages until parts stop working or even begin to control the wrong pain response. By applying magnetic pulses to the damaged part of the brain, human trials are already underway to see if these damaged pathways can be restored. From the demonstration given last night, it seems rather likely that they can and that results are almost instant and quite significant. All from sitting with a cap full of sensors on for a few minutes!

Now, these seem to be pretty viable treatments. Certainly, the fact that the Trans Cranial Magnetic Treatment  just outlined, is at the human trial stage, implies that if successful, it could be available within a few years, rather than decades. Developing a specific drug to block a gene such as SCN9A is still incredibly specialised, but isolating the gene at all is an enormous step forward. Those of us who live our lives in terrible pain, day in and day out, suddenly may have a glimmer or two of hope after all.

Do watch the programme, there are other parts that spoonies definitely need to see - one treatment is so simple, we could all do it through periods of acute pain. It simply relies on the fact that the brain can only respond to so many stimuli at once. A burn victim suffering unthinkable pain as his dressings were changed was fitted with - a virtual reality computer game!! Yep, the actions of firing snowballs at penguins and being unable to see or become anxious about anything being done to him in the room, was enough to take his pain score from almost unbearable to practically non-existent.

So, I'm off to GAME to get a virtual reality, coalition-busting environment, where I get to throw custard pies at George Osborne and David Cameron. I'll tell you how it goes....

16 comments:

  1. The iplayer Program ID is b00ybvz6 - it should be available for a few days at http://www.bbc.co.uk/iplayer/episode/b00ybvz6/Horizon_20102011_The_Secret_World_of_Pain/
    It's an hour long.

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  2. Sue, Eoin tells me that the health proposals have been passed by a majority of 100, that all the Coalition supported it and a quarter of Labour MPs did not oppose.
    Please tell him he must be mistaken…. Aneurin Bevan, what have they done?

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  3. This article made me smile. Hopeful signs for people who suffer awful constant pain, both not and in the future.

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  4. Stephen - Good! Me too

    Pam - It was 86!! Terrible enough. About time we find out who didn't vote
    321 ConDems out of possible 364
    235 Lab & "others" from a potential 286

    So 556 out of 650!!!

    It's a bleeping disgrace is what it is!! Where were the other 94? They should have their bloody salaries stopped (unless they were condems who abstained of course, lol)

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  5. The programme and the cases highlighted made me think that my pain isn't really that bad! :)

    The drug that I referred to in a previous post on here, is the dissociative, Ketamine. Considering they showed a CRPS sufferer on the programme last night, I am amazed they didn't mention it. It is a bit of a wonder-drug in my lay-opinion. There have been cases where CRPS has been cured, pain-wise - something unheard of before with any medication.

    I also believe it would be of massive benefit to IBD sufferers… as it doesn't effect GI function. It is also non-addictive and non-drowsy (unlike opiates) as well as having a massive dosage range. (Sorry for repeating)

    http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#Ketamine

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  6. Kevin.
    Ketamine needs to be given under controlled conditions where resuscitation is immediately available. To say it is non drowsy is incorrect and the dose range is very limited. It can be an extremely dangerous drug if not administered by a suitably experienced doctor.

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  7. I have to admit to having cried along with the lass whose pain was removed by the rTMS treatment! Oh, the relief and the release would be bliss! The people running the rTMS trials say that over the course of treatments relief is obtained for days or sometimes weeks. If that could be combined with gene-therapy, oh my...

    This is the link to the programme's dedicated web-page which has links to all sorts of useful related stuff and full production credits: http://www.bbc.co.uk/programmes/b00ybvz6

    The programme is available on that page for 20 days :-)

    xJ

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  8. Mark,

    As I understand it, low-dose (ie: management dose) Ketamine doesn't cause drowsiness in the same way opiates and benzos do (ie: 'nodding') - which is the context I meant it in. It can be a hypnotic, though, so yes, in this way it can be called drowsy. Having said that, some reports say it can be stimulating at certain doses, so…?

    The dose range is huge. From tens of mg - to hundreds of mg for general anaesthesia. Because of this range, I do not believe it to be "extremely dangerous", especially compared to the overdose potential of opiates. How many ketamine overdoses have been reported, for example?

    Furthermore, Ketamine's 'safe' reputation comes from the battlefields of Vietnam where it was used precisely because it didn't need to be administered by a experienced doctor. It is also used on children and the elderly as well as in trauma victims where fluid levels are not know (again, the large dose range is useful here)

    I have been looking into it for a while now in a search for a panikiller that I can use (I can't have opiates or NSAIDs) to manage bowel pain when my Crohn's flares up ( I also hate the side-effects from high dose prednisolone, by that's another story).
    A company called Javelin wants to release (or have released) a ketamine nasal spray that is suitable for self administration. This would be ideal as a non-opiate based pain management solution…

    http://ir.javelinpharmaceuticals.com/releasedetail.cfm?ReleaseID=209623

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  9. Kevin
    I can understand many people's wish to find the "magic bullet" of pain relief, and I'm one of them. But please don't put too much faith in Ketamine. What you've interpreted as a wide dose range is not an indication of safety. It varies because of the different routes of administration and the need for accurate dosage based on bodyweight: too little and it's ineffective, too much and you cause respiratory failure. Please look it up in an authoritative source such as the BNF.
    I understand from those who work in chronic pain management that its use is unproven. Clinical studies have not shown any significant evidence of its benefit in chronic pain management.

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  10. Surely ketamine is addictive anyway? I watched a prog once and users were desperate - teeth falling out, etc.

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  11. Mark,

    As I recall, the BNF which I have doesn't have much on Ketamine other than its indications / contraindications… but I will find it and take a look. :)

    I was looking at the safety aspect from a risk of overdose point of view and as a comparison to opiates - which seem to be used quite casually sometimes in my opinion.

    Risk of respiratory failure is only a concern with a massive, IV dose - and is of lower risk than that of IV opiates. It isn't an issue with other routes of administration or self-administration. Oddly enough, Ketamine can be used to treat respiratory failure in asthmatics.

    I understand that some people regard it as un-proven, that's why I think it needs looking into. I am suggesting it can be used for acute pain, not chronic pain as you mention above - mainly as an alternative to opiates.

    There are many links and reference that I have read that suggest it can be used in this sort pain management. I appreicate your input, so If you can share any information to the contrary, including anything to do with death from overdose / respiratory failure, then I'd be grateful. As you can tell I am very interested in this - I should have been a pharmacokineticist… or is it a pharmacodynamicist? :)


    Sue, Ketamine not physically addictive in the sense that it causes withdrawals, like opiates, alcohol, benzos, etc. It might be psychologically addictive - but so can chocolate! :) I also don't think you should take anti-drug propaganda seriously either! :D

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  12. Fair points Kevin - I'll take time to look into it properly. I know I've had it as part of an anaesthetic package for surgery.

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  13. Very interesting show. I can remember the early use of distraction therapy in childrens daycase theatres...a type of mild hypnosis with sock puppets. Allowed the scrub staff to get cannulas into youngsters before the days of emla cream.
    Ketamine
    Hmmm
    Well known horse tranquilliser. Early trials as a pain killer for bone cancer were unsuccessful due to the doseages needed. I have seen several people treated in ED for overdoses, as its a pretty popular recreational drug. In fairness most had taken a coctail so the exact cause of respiratory arrest was unclear. Some responded to narcain (opiate antagonist, so opiods were likely at fault) and some didn't. As for treatment for asthma, well this is very misleading...although ketamine has some action as a bronchodilator, it is only used in such cases as part of the emergency intubation cocktail. So when all other treatments have failed and the patient is going to die without mechanical ventilation. There is a very long list of reasons that makes mechanical ventilation in asthma a last resort. You need to be very careful when interpreting stuff on the web and check your sources.
    Had a chat with one of our gasmen who is part of the chronic pain team. His view of ketamine is as follows
    1) variability of dose required by individual patients makes it difficult to monitor efficacy
    2) most clinical trials have had high drop-out rates due to side effects (mainly the hallucinations and sedation)
    3) its currently only available as a liquid for injection, so outside of a clinical trial no tablet form is available. The fact that BigPharma doesn't want to go down this route is not suprising as so far there is little evidence that a tablet would be of use.
    Finally, a quick metasearch on Medline or EBL/NIH databases shows very little reason to think that ketamine would be of use for chronic pain management, other than anecdotal evidence that its a pretty good antidepressant when combined with haloperidol. Just my tuppenceworth.

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  14. Thanks for the update Dino-nurse.

    Check your sources (:P) - Ketamine isn't a horse tranquilliser. Used in veterinary anaesthesia due to not needing breathing apparatus. Definitely not a tranquilliser (Not that the term is used much these days anyway)

    As in the link I posted above, there is a ketamine nasal spray - which seems to be used as an alternative to opiates for acute pain. I understand that it isn't very active orally, so probably why no tablets. I am also not talking about IV infusions, which, obviously, would require careful monitoring.

    The reason I have revisited this posting was to share a link regarding ketamine and its use in treating phantom limb pain. As I tried to explain previously, I think there could be some positives in its use, as it seems to have helped a number of people in specific ways…

    http://www.viceland.com/int/v18n2/htdocs/interview-with-ketamine-chemist-704.php

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  15. Excellent post Sue! I don't own a tv but will have a look online... and look into getting one of those headsets before I break another lamp and damage another wall out of sheer frustration at my inability to get decent pain relief!

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  16. Chronic pain sufferers should certainly not lose hope. Things can get better. There is a growing community of researchers and doctors who are doing their best to help and come up with a cure. Stay positive and keep fighting!
    sympathetically maintained pain

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