The Opioid Epidemic – Addressing Pain in the 21st Century

From an article published in My Authentic Life.

Written by Dr. Krishnan V. Chakravarthy MD, PhD – Laboratory Head Chakravarthy Lab San Diego, Department of Anesthesiology and Pain Medicine UCSD Health and VA San Diego Healthcare (San Diego, CA, USA) and Frank J. Boehm – CEO – NanoApps Medical Incorporated (Vancouver, BC, Canada).

Upwards of 50 million people suffer from some form of chronic pain in the US alone, where three million of these individuals experience neuropathic pain. On a global scale, chronic pain impacts close to 1.5 billion individuals, with 25% enduring lower back pain. As we all know, even slight pain associated with a throbbing toothache can throw off our day, distract from our concentration on important material, and impact our relationship with others. More intense chronic pain can distort and significantly alter virtually every aspect of our lives. It is therefore not surprising that this situation has led to the emergence of the current opioid abuse epidemic, where people are simply desperate to find relief!

In the midst of humanity’s attempts to grapple with this immense and increasingly vexing challenge, novel technologies are rapidly emerging that show great potential for the sustained alleviation of pain in all its forms. How do we as patients, understand and maneuver through this multitude of different options, while still making sense of what is best for our mind and body. How do we convey the suffering that we are undergoing to physicians? After all, pain is an individual sensation; in fact, due to a genetic deficiency, there are certain individuals who do not feel pain. How then, can we make physicians understand? We live in an age where information is accessible to practically everyone; hence, questions become just as important for us as patients to serve as educators for the physicians who we interact with. These are the questions that we pain doctors ask and introspect all across America when patients walk into our offices.

The flow of knowledge and teaching is no longer considered to be unidirectional. It is important for pain patients to embrace their health, come to an understanding themselves and their needs, and to be cognizant of what options are available to them. Whether simply pharmacological treatments, injections, minimally invasive surgery, or holistic medicine; pain caregivers and patients are transitioning toward partnerships. Given the increasing consumer pressure for high quality healthcare, physicians sometimes overlook the basic tenets of medicine, where ultimately, they are healers and teachers. We cannot expect to deliver the best quality care without providing the time to listen, with an empathetic heart.

For most patients the message is simply that they should strive to learn and educate themselves, and to engage as active participants in their pain care. They can easily learn about what the latest treatment options are. For example, novel therapies are emanating from the still nascent disciplines of nanotechnology and nanomedicine. Nanotechnology can be defined as the science of the very small, which involves the capacity to control matter at the atomic and molecular levels, whereas nanomedicine may be defined as the application of nanotechnology to medicine. At these microscopic scales, typically at dimensions of from 1-100 nanometers (1 nanometer = 1 billionth of a meter), many materials have completely new and enhanced behaviors when compared to their macroscale counterparts. For instance, nanoparticles may more efficiently conduct electricity, heat, and cold, react to magnet fields differently, and sometimes have dramatically different chemical reactions, such as in catalysis. All of this translates to enhanced properties that may be of immense benefit to medicine.

The potency of nanomedicine relates to its ultraprecision for the treatment of diseases, and for the purposes of this article, pain, down to the single neuron level. Nanomedicine functions, and has influence at the scale of individual cells and molecules, which is exactly where many diseases, as well as pain, originate. For example, nanoparticles, or what can be referred to as “nanocarriers”, can be loaded with very powerful pain medications and “decorated” with certain targeting molecules, which ensure the delivery of these drugs directly to numb nerve cells, or shut down specific cells within the brain that convey the perception of pain. This means that the body will not be flooded with drugs or suffer their negative side effects, as is typically the case with chemotherapies. Therefore, far lower doses of a drug are required, while imparting a significantly greater pain relieving effect. In the future, much more sophisticated autonomous nanomedical robots may have the capacity to directly intervene and block the signals within individual nerve fibers that transmit pain, which will translate to the negation of the requirement for pain medications altogether. These classes of nanotechnology based nanomedical capabilities will give rise to a completely new paradigm in pain medicine and pain relief for the 21st century.