This article is one in a series on Medications for Pain…  What are your choices?  How do various medications work?  What are the pros and cons?  How about side effects?

Today we’ll look at what medication advances are coming soon.  How exciting!!

1.  Improvements to opiates (narcotics)

While opiates or narcotics are sometimes helpful, they have more than their share of negatives.  Being researched right now are selective narcotics that give better pain control while having fewer side effects.  Instead of working everywhere in the body, they’re being designed to work at pain sites, but not at so many other sites (for example, in your digestive tract) where they cause the problematic side effects.

Another improvement is medication that will decrease side effects, such as this medication for the side effect of constipation from opioids.

2.  Different delivery systems for narcotics

Narcotics are being developed to be given either by inhalation (in inhalers, like asthma medication) or through the skin inside your mouth or nose (by rubbing a little gel there).  Why?  Medications used in these ways work faster and can last for a shorter time.  These delivery systems may be very helpful for people who have “break-through pain,” which are short-duration spikes of pain.  In the past, these short flares of pain were hard to treat because medication didn’t work fast enough, or lasted too long.  And, because of other advantages of getting medication into your body in these ways, lower overall dosages can be used, which also mean fewer side effects.

3.  Using medications more safely

Research is being done to see how to use the medications we have now more safely.  For narcotics, how do we avoid tolerance (tolerance = your body “gets used to” a dosage, so to get the same benefit, the dosage must increase).  We’re finding that another pain medication, Ketamine, may be helpful to prevent tolerance.

Ketamine itself has shown promise in some pain disorders, but remains controversial, in part because of Ketamine’s side effects.  Research is also looking at how to use this medication more safely…  in particular, what medications can be used along with Ketamine to protect the nervous system.  Several studies have been published this past year about Ketamine, and definite progress is being made to determine what disorders this medication is useful for, and how to use it more safely.

4.  Using genetics to predict which medication is right for you

Research in depression is studying how to use your genetics to predict which serotonin antidepressant is right for you, from a choice of 10 or so.  No guessing, no waiting…  just a simple blood test which can be used to say, “This one should work the best.”  We’re not at this stage yet with pain medication, but my hope is that such tests will be available in the not-too-distant future, to predict which particular medication in any class of drugs is right for you.  For example, which  narcotic?  Or, Lyrica versus Neurontin?  Or, Cymbalta or Effexor?  This would save a lot of time – no using a medication which won’t ever work anyway - and prevent a lot of side effects.

In this series:

1. Medication for Pain Series 2009
2. Aspirin, Motrin and NSAIDS
3. Anticonvulsants
4. Antidepressants
5. Anesthetics
6. NMDA receptor antagonists (e.g. Ketamine)
7. Muscle relaxants
8. Blood Pressure Medication
9. Narcotics (Opiates)
10. Anti-Psychotics
11. Medication Advances Coming Soon
12. Research Advances