More than 400 researchers and clinicians gathered in Bethesda, Maryland March 5-6 to discuss a growing public health challenge: balancing appropriate pain treatment with efforts to minimize prescription opioid misuse. NIDA co-sponsored the conference, "Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients," with the American Medical Association and in conjunction with the National Institutes of Health Pain Consortium.
About 50 million people suffer from chronic pain in the United States, and opioids are the most powerful medications available for most types of pain. However, opioids can lead to negative health consequences, including abuse and addiction. The number of prescriptions written for opioid pain relievers has increased dramatically in recent years, thereby increasing opportunities for abuse. Treatment advances may improve pain relief for patients while reducing the risk of abuse. Dr. Pamela P. Palmer of the University of California, San Francisco, an anesthesiologist and pain medicine physician and researcher, discussed ways that opioid medications can be formulated to minimize the risk of abuse. Extended-release or crush-resistant formulations tend to offer a better safety profile and reduce the potential for abuse. For example, putting opiates into a gel matrix from which they cannot be extracted for the purposes of abuse may prove to be a successful strategy. Similarly, new devices that dispense opioids more safely also may improve pain relief for outpatients and inpatients.
A new class of opioids—designed and synthesized by NIDA-funded researchers—that targets functionally paired receptors in the brain may provide pain treatment with fewer side effects to patients and less potential for abuse. The team is testing the compounds in animals, says Dr. David J. Daniels of the University of Minnesota, with promising results: with chronic administration, the pain relieving effects of the compounds do not diminish nor does physical dependence develop. Behavioral assays in animals also suggest that the compounds would have low potential for abuse.
With training, people may be able to harness the power of the brain to fight pain. Dr. R. Christopher deCharms of Omneuron, Inc. in Menlo Park, California, leads research in this new approach to pain management. The strategy involves training participants to control the activity of neural regions linked with pain by viewing real-time functional magnetic resonance imaging (rtfMRI) scans of their brains. Volunteers and people with chronic pain who receive such training can alter the activity of a key brain region with concomitant pain modification—a result not seen among participants who trained without the rtfMRI. Dr. deCharms and colleagues continue to test this approach to chronic pain management and have expanded studies to substance abuse treatment.
Meeting participants agreed that research is urgently needed to support the development of pain treatments with little or no risk of abuse and the identification of patients who may be vulnerable to opioid abuse and addiction. Filling such research gaps will ultimately provide evidence-based guidance on pain management that minimizes the risks of opioid abuse and addiction.