Living with pain: new relief for neuropathic pain
Four million Americans are haunted by a phantom. It's called neuropathic pain, and it burns like fire, stings like a thousand sharp needles, and has no obvious physical cause. But now there are two balms that can help to assuage the pain. One is a drug combination, and the other is a new use of an existing medication.
Neuropathic pain is driven by nerves gone wrong. They send a pain signal when there's no body damage to trigger it. Sometimes they even send it when there's no body part—phantom limb pain, which amputees feel in their missing arms or legs, is neuropathic. So is pain felt in the limbs of diabetics, pain in people with multiple sclerosis, some kinds of back pain, and pain persisting for months after an outbreak of shingles.
The nerves often seem to become hyperactive.
"It's very difficult to treat, because the problem seems to be inside the nervous system itself," says Ayman Basali, a physician in the pain management department of the Cleveland Clinic. It's often misdiagnosed and undertreated—the all-too-familiar "it's all in your head" refrain from doctors who can't find a body injury to blame for the pain—so people spend years in agony.
"Unfortunately there's no single best treatment for it, and what works in one patient doesn't work in another," says Basali. "A lot of what we do is trial and error with different therapies."
Earlier this month, at an international pain conference held in Istanbul, doctors announced that two drugs combined to deal with this kind of pain are better than either one alone. Magdi Hanna of King's College Hospital in London treated over 300 patients with gabapentin, an antiseizure drug that's often used for chronic pain. For half the group, the researchers added oxycodone, an opioid painkiller. The combo knocked patients' feelings of pain down by 33 percent. Gabapentin slows down nerve signals, and opioids dull the brain's perception of discomfort. The two working better together than alone, Hanna says, underscores the fact that chronic pain has complex causes and should be treated by more than one type of therapy.
The same week as the pain meeting, another drug that slows down nerve activity, called pregabalin, got the green light from the European Commission to be used for neuropathic pain. A clinical trial of 137 patients with spinal cord pain showed that 40 percent of them lowered their pain scores by more than 30 percent after using it. The drug, sold as Lyrica, is already approved in the United States to treat nerve pain in diabetic patients and also for pain after shingles. Basali says the approval will likely prod doctors on both sides of the Atlantic to expand the drug's uses and extend its nerve-calming effects.
advertisement
