Opioid therapy helps with chronic pain

Opioids can clear the pain memory and help patients with chronic pain

17/01/2012

The targeted use of opioids could be a new hope for pain patients. Researchers from the Austrian Center for Brain Research at the Medical University of Vienna have found out in a study paper that apparently chronic pain without an organic background can be treated and eliminated not only in the short term but also over the long term. If a correct dosage has been set, you can „chronic pain conditions disappear forever“.

Pain without direct pain
For a long time, patients and doctors complain that the treatment of chronic pain is inadequate. Experts estimate that more than 10 million people in Germany alone suffer from chronic pain. Most patients take pain medication on a permanent basis and some experience pain, although they are not exposed to direct pain. In the past, those affected were once given over moderate to severe pain impulses over a longer period of time. A kind of fixation on the pain site causes pain to the brain, although an organic pain center is missing. Physicians and scientists have already found in various research that a type of pain memory makes the person over-sensitive. As a result, they respond to pain even at the slightest change or touch, because the pain pathways are highly sensitive. Incidentally, the memory for pain is located in the spinal cord.

Declining excitation threshold due to pain experiences
The stimuli are transported by nociceptive fibers to the spinal cord. There the pain stimuli meet the first synapses. The information is then forwarded to the brain, among other things. If a patient experiences repeated pain, pain information is passed on in the same way over and over again. „This reduces the excitation threshold“, The researchers explain why the patient then reacts sensitively to minimal external stimuli or changes. Physicians call this process synaptic long-term potentiation (LTP). Researchers from Austria from the Center for Brain Research of the Medical University of Vienna report in the journal „Science“ a new pain therapy for chronic pain sufferers. Opioids, in their opinion, can not only achieve a short-term effect, but completely rid the patient of chronic pain of their suffering. „It depends mainly on the correct dosage“, as the team explained.

Short therapy with high-dose therapeutic
During short-term therapy with certain high-dose opioids, the memory trace of the pain can be erased. Opioids have long been used in conventional pain management. For this purpose, natural but also chemical substances are used, which have a morphine-like nature and dock on effective. To substantiate the thesis, the research duo led by Ruth Drdla-Schutting and Jürgen Sandkühler undertook various animal experiments.

During the study, rats were given electric shock while in the narcotic state. Due to the unconscious experience of pain they changed and a pain memory in the spinal cord was created. The animals were given a morphine-containing analgesic intravenously. The opioid was given for 60 minutes and in high dose. This is a novelty because so far the therapeutic agent is injected only in medium dose but continuously pain patients.

Pain memory is deleted
In the evaluation, the doctors made an amazing discovery: „The entire memory trace that was previously placed was erased after the high-dose therapy.“ If this treatment approach were to work well under clinical conditions, it would be „a paradigm shift in pain therapy“ as study author Sandkühler emphasized. The result of the research could soon revolutionize the treatment of pain. Instead of the previous dosage and application, the Wiener Weg could provide new effective treatment options. Instead of long-term drug therapy, a high-dose but entertaining in the future could free patients from pain faster. Whether the new type of pain treatment will be successful in humans will now need further studies. Until it comes to a release of the therapy, it requires numerous and detailed research.

For example, patients who suffer from chronic back pain due to wear and tear, even a new dose will not bring a positive long-term effect, because first the background disease must be treated and clarified. On the other hand, those afflicted with phantom and stump pain after injury to the extremities and amputations may hope for a speedy relief. It is still unclear when the first clinical trials with human volunteers begin. It may take a few more years before the new therapeutic approach is implemented. (Sb)

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