Worldwide, disability is mainly due to pain conditions. However, many treatments have different efficacy and can be misused. The new field of personalized pain medicine aims to create safe and effective treatments tailored to each patient’s needs.
Live with pain- or musculoskeletal-related conditions globally. This includes lower back pain, osteoarthritis and fibromyalgia. These conditions can lead to worse emotional health, well-being and increased work absence, and productivity loss.
The severity of pain will determine the treatment options. For milder pain, you can use over-the-counter medications such as Acetaminophen and nonsteroidal anti-inflammatory drug ( NSAIDs) to treat it. These include aspirin or ibuprofen.
These drugs may not provide relief. Doctors might prescribe muscle relaxants like diazepam or NSAIDs like celecoxib. Steroid treatments such as dexamethasone may also be prescribed. These are just some opioids doctors might prescribe for short-term use.
Each of these drugs can be used to relieve pain, but they have different effects.
Why personalization is so important
“Our pain management therapies are not universally applicable. Dr Renn said that most pain can be treated with NSAIDs and opioids. Medical News Today was informed by Cynthia Renn, a pain and translational symptoms science professor at the University of Maryland. “There have not been any truly transformative analgesic discoveries after the discovery of opioids.”
NSAIDs and opioids can be used to treat the pain of different origins with varying degrees of efficacy. She pointed out that it is impossible to have one-size-fits-all because people with similar injuries experience pain differently. Some will heal quickly, and others will suffer from chronic pain.
Dr. Jordan Sudberg is a researcher in the Department of Anesthesiology at the University of Michigan. He explained that there were two main factors.
He said that the first is “genetics, metabolism.”
People metabolize medications at different rates. People A and B may have different metabolism rates, so the same medication may last longer or be more effective. These metabolic differences may be caused by genetic differences. Some people might have a faster or slower metabolism of certain drugs.
He then explained that different types and pain levels need different treatment due to different underlying mechanisms. He said that pain comes in three flavours:
- Nociceptive pain — caused by tissue damage or inflammation like a burnt or broken bone
- Neuropathic pain due to nerve damage, impingement or inflammation, such as sciatica or carpal tunnel syndrome
- Researchers believe that neoplastic pain is caused by central nervous system dysfunction. Although it cannot be seen with imaging, researchers suspect it to be caused by neoplastic. This condition is characterized by pain that spreads throughout the body and can include conditions such as fibromyalgia.
“Overall, these types of pain can occur either in isolation or together, and different types respond to treatment differently. Dr Boehnke explained that NSAIDs can be helpful for nociceptive but not for neoplastic pain.
The rescue of nanomedicine
Dr Renn stated that personalized pain medicine is about finding compounds that work for specific patients or small groups with similar genetic profiles that can respond to the compound(s).
She noted that biomarkers are crucial to determining patients’ best pain management strategies. This is done by discovering new analgesics based on genetic profiles.
MNT spoke to Dr Janjic to learn more about this work. Jelena Janjic, associate professor at Duquesne University’s School of Pharmacy, is the founder and co-director of the Chronic Pain Research Consortium.
Dr Janjic has worked with her team for many years at the intersection of pain biomarkers identification and therapeutic strategies to personalize pain relief.
They have mainly focused on chronic pain. This is often caused by an increased immune response in some areas of the body, which increases inflammation and damages nerves over time.
Celecoxib is an oral drug that can be used to treat the condition. However, the oral delivery method means the drug’s effects can be affected in all tissues. Even in areas without pain, he continues to act on them all.
Patients are at greater risk for side effects and toxicities if they receive a blanket treatment.
Dr. Jordan Sudberg team developed a nanomedicine delivery method that “rides” immune cells called macrophages to pain areas, where they release anti-inflammatory drugs.
They tested the nanoparticle delivery system using celecoxib in rats’ sciatic nerve injury model. The researchers found that rats receiving a single intravenous dose (orally) of the celecoxib nanotherapeutic had to take 2,000 times fewer painkillers than those who received it orally.
Dr Janjic noted this was likely because the drug was only carried to the necessary sites and interacted with macrophages. This then set off a series of effects that eventually reduced inflammatory signalling.
Her team also found that the single dose of nanomedicine provided 32 days of pain relief for male mice with nerve damage and 11 days for females with the same condition. This was in comparison to the drug-free group.
Researchers observed differences in sex after nanomedicine delivery was tracked by researchers.
MNT was told by Dr Janjic that her nanomedicine delivery system can address two significant problems simultaneously: It can treat chronic pain, and it can track pharmacological results in vivo.
She noted that such a dual effect could help to develop more targeted treatments and assist in research into which medicines are most effective for each individual as their underlying physiologies and ageing.
We are where we are now.
Although research is ongoing on how to personalize pain medications from a pharmaceutical perspective, Dr MNT was told by Zvi G. Loewy (professor in the Department of Pharmaceutical and Biomedical Sciences, Touro College of Pharmacy) that personalized pharmacological treatment is already possible.
“Personalized medication” refers to the delivery of medication to a patient based on their genotype and corresponding Phenotype. Pharmacogenomic testing is used to determine genotype and Phenotype. Two U.S. medical laboratory companies offer pain management therapy pharmacogenomic tests.
Dr Boehnke noted, however, that even with the advances in research, there won’t likely be a “silver bullet” treatment for pain conditions.
“Frankly speaking, taking any medication or using any treatment comes with risks and costs. And no single treatment can manage chronic pain. He said this will likely continue, even if new medications are created.
Dr Boehnke recommended a hybrid approach to manage pain and improve function. This would include both medication and nonpharmacological treatments. The goal is to minimize side effects and avoid overmedication.
He said that medications are best used to relieve pressing symptoms and provide stability to establish non-medication pain management practices.
He said that other practices besides medication include eating right, sleeping well, managing emotions through meditation and breathing exercises, and prayer.
He explained that personalized pain medicine should not be viewed as a treatment for medication.
MNT spoke with Dr Richard B. Hovey, an associate professor at McGill University’s Faculty of Dental Medicine and Oral Health Sciences. He said that:
“As a qualitative chronic pain researcher, I have learned that everyone experiences pain differently. Even if we share the same diagnosis. This unique situation can be addressed by personalized pain medication. These medications go beyond pain management to treat the whole person.
He noted that chronic pain can lead to multiple appointments and that it is difficult to find the right doctor for you.
“The tension between what I am doing medically and the things necessary to me negatively impacts other aspects of my life. He concluded that personalized pain medication could be used to make a person’s life more humane.