Ending Chronic Pain the Key Medical Innovation of the 21st Century?

Treatment for chronic pain has changed very little over the last fifty years. Now however it is feasible to identify molecules which can act as analgesics without entailing the notorious adverse side-effects.

While transhumanist thinkers hold out the promise of enhancing and optimising the human body by means of biotechnologies, at the other end of the scale the Analgesia Institute is working to promote a unified approach to the management of chronic pain using less invasive analgesics. Chronic pain affects on average one adult European in five, a percentage which increases with age. Medical practitioners in the 20th century became able to treat this type of pain with pharmaceutical products, from morphine (discovered in 1803) and aspirin (in 1899), to the more recent Ibuprofen and anti-depressants from the 1960s onwards. The cost of pain management worldwide, using solely the drugs available today, is estimated in the tens of billions of dollars. Nevertheless these solutions are still inadequate and innovation is sluggish despite huge investment by the pharmaceutical industry. Now the Analgesia Institute, founded in 2008 as a part of the University of Auvergne at Clermont-Ferrand in central France a cluster of a dozen public and private institutions is conducting research which goes in the opposite direction to that usually taken by the pharmaceutical industry. Drawing on data from patient consultations, they have been tracing back the paths taken by different molecules with analgesic effect..

Analgesics are categorised according to the intensity of the pain they are able to treat, ranging from paracetamol to strong opioids of which the best known is morphine. The strongest morphine derivatives are undoubtedly no less effective than when they were discovered, but they do have the disadvantage of entailing serious side effects such as nausea and addiction, which means they cannot be widely prescribed except to treat acute pain. However, researchers working at the University of Auvergne have been trying to find a way to get rid of the side effects of morphine treatment. They have succeeded in isolating a particular potassium ion channel known as TREK-1, which inhibits neuronal activity, thus acting as an analgesic but without the usual side effects. Alice Corteval, Operational Director at the Analgesia Institute, explains that once you understand the path that the analgesic effect takes, you no longer need to actually use morphine because there are other molecules which can do the job just as well. In fact the teams working at the Analgesia Institute have already progressed from the research phase to successfully synthesising several such molecules.

Other innovations designed to treat pain use a similar approach, which consists in isolating neuron receptors activated by the passage of an analgesic that can then be re-activated by using synthetic molecules. For example neuropathic pain, which results when highly sensitive nerves are damaged, can be treated with medicine that is therapeutic but not in itself an analgesic. Moreover, quite apart from pain treatment, by taking research into pathology in general upstream, the Analgesia Institute is helping to create a new holistic approach to the medical treatment of both people and animals, which has over-used antibiotics, leading to widespread antimicrobial resistance (AMR) that is now rendering some once-powerful antibiotics ineffective. As Alice Corteval explains, this One Health concept takes a wider view of the food chain, focusing on the need to find new ways to treat pathology in farm animals as this is ultimately linked to human health through the meat we consume.

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Ending Chronic Pain the Key Medical Innovation of the 21st Century?