Pubdate: Sun, 18 Mar 2007 Source: Milwaukee Journal Sentinel (WI) Copyright: 2007 Journal Sentinel Inc. Contact: http://www.jsonline.com/news/editorials/submit.asp Website: http://www.jsonline.com/ Details: http://www.mapinc.org/media/265 Author: Lauran Neergaard, Associated Press DOCTORS SEEK PAIN RELIEF WITH LESS ADDICTION Doctors Look For Way To Get A Handle On Pain Medications, Ease Patient Fears Washington - Scientists are hunting new ways to help millions of pain sufferers - from addiction-resistant narcotics to using brain scanners for biofeedback - amid a worrisome rise in abuse of prescription painkillers. The good news: Only a tiny fraction of patients who appropriately are prescribed the most powerful painkillers - drugs known as opioids, including morphine, Vicodin, fentanyl and Oxycontin - become dependent on them. And scientists told the National Institutes of Health recently that those few who are vulnerable tend also to suffer such psychiatric disorders as depression and anxiety, giving doctors a clue about which patients need closer monitoring. Opioids "are not dangerous if you know how to use them properly," said Nora Volkow, chief of NIH's National Institute on Drug Abuse. Amid fears that rising painkiller abuse will spark a backlash against pain sufferers, Volkow organized a two-day meeting involving several hundred scientists and primary care physicians to bring the latest science on pain and addiction to doctors struggling to balance the drugs' clear benefits and potential harm. Chronic pain affects one of every three or four adults worldwide. The government says one in 10 Americans suffers pain that lasts a year or more. For millions, pain is severe enough to be disabling; up to 6 million patients are on long-term opioid therapy. It's not just a question of suffering: Serious pain actually can worsen recovery from various ailments. How many need opioids but don't get them? Those numbers are hard to come by, but "pain is really under-treated in our society," opioid specialist Christopher Evans of the University of California, Los Angeles. By some estimates, as many as 40% of cancer patients and the terminally ill don't get those medications. At the same time, prescription drug abuse, particularly of opioids, is on the rise. One in 10 high school seniors admits to popping Vicodin for non-medical purposes, and recent studies suggest about 2.2 million people age 12 and older first abused painkillers in the past year, outpacing new marijuana users. Some 415,000 people received treatment for painkiller abuse last year. So the hunt is on for pain relief that minimizes the abuse risk - not just for the 2% of pain patients who might become dependent, but to discourage theft or other diversions. Under research now: . Pain Therapeutics Inc.'s Remoxy is in late-stage clinical trials to see if it offers an abuse-resistant version of oxycodone, the ingredient in Oxycontin. Oxycontin tablets are supposed to slowly dissolve for long-term pain relief, but abusers crush them and snort or inject the powder for a fast high. Remoxy is a thick gelatin version of oxycodone - crushing it just yields goo. . Also being studied is a combination of naltrexone, a drug used to reduce alcohol craving, with oxycodone. The extra drug should tamp down oxycodone's brain-stimulating effect, but one question is whether that also will diminish pain relief. . Another approach in early trials pairs technology with tiny tablets of a hospital-strength opioid, sufentanil, redesigned to dissolve almost instantly under the tongue. A computerized dispenser, the size of a remote control, is programmed with the patient's dose of Nanotabs and records how much is used and how often, information the doctor would require before allowing refills or adjusting doses. Then there's the non-drug approach: Omneuron Inc. and Stanford University researchers are trying to teach patients to control how much pain they feel by scanning their brains and showing them the real-time MRI images as they try different techniques. "The brain is built to be able to modulate its pain-control processes," says Omneuron chief executive Christopher deCharms. "We're teaching people to gain conscious control." - --- MAP posted-by: Steve Heath