The new pain treatments that may finally stem the need for opioids - New Scientist

Why talk and behaviour-based interventions that don't use any drugs, as well as genetic therapy and bacterial toxins, are promising new weapons in our fight against pain

Health 16 November 2022

By Stephani Sutherland

Anthrax bacteria in lung. Coloured scanning electron micrograph (SEM) of a cluster of anthrax bacteria (Bacillus anthracis) in a capillary of the lung. These rod-shaped, Gram-positive bacteria are highly pathogenic. Commonly an infection of livestock, B. anthracis is transmitted to humans by contact with contaminated animal hair, hides or excrement. Two forms of the disease occur: pneumonia in the lungs (woolsorter's disease), and cutaneous anthrax, which causes a large boil at the site of the bacteria's entry. Antibiotic treatment, if prompt, may be effective for the skin infection. Pulmonary anthrax is fatal in most cases. Magnification: x540 at 6x7cm size. x1750 at 7.5x9.5"

A cluster of anthrax bacteria

Science Photo Library

TENS of millions of people live with chronic and in some cases disabling daily pain in the US alone, in addition to those experiencing acute pain. Yet treatments for pain relief remain only partially effective and only work for some people.

For instance, paracetamol (acetaminophen) may have little or no effect on extreme pain and exceeding the recommended dose can be toxic to the liver. Similarly, ibuprofen and other non-steroidal anti-inflammatory drugs – which tackle the inflammation that presses on nerve endings and causes pain – have a range of side effects, including headaches and indigestion, as well as interacting with drugs used for several other conditions. This leaves opioids, which mimic the body's natural painkillers and are among the most effective form of pain relief.

Yet while opioids may work for many types of acute and chronic pain, they can be ineffective against others, and are associated with addiction and the risk of overdose. The opioid epidemic has cost hundreds of thousands of lives in the US and has underlined the need for alternative treatments. But as John Wood, a pain researcher at University College London, puts it: "There has been a tremendous succession of failures trying to make new analgesics."

For years, pharmaceutical companies had been looking for a way in through a single gene that might be vital for pain, he says. So, in 2006, when a team led by Geoff Woods at the University of Cambridge discovered such a gene, called SCN9A(see "What is pain, how does it work and what happens when …

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