The Painkilling Power Of Opioids, Without The Harm?

When it comes to painkilling medications, they can generally be categorized into two kinds:

• non-opioids (e.g. ibuprofen, paracetamol/acetaminophen, aspirin)
• ones that actually work for something more serious than a headache

That’s an oversimplification, but broadly speaking, when there is serious painkilling to be done, that’s when doctors consider it’s time to break out the opioids.

Nor are all opioids created equal—there’s a noteworthy difference between codeine and morphine, for instance—but the problems of opioids are typically the same (tolerance, addiction, and eventual likelihood of overdose when one tries to take enough to make it work after developing a tolerance), and it becomes simply a matter of degree.

See also: I’ve been given opioids after surgery to take at home. What do I need to know?

So, what’s the new development?

A team of researchers have found that the body can effectively produce its own targetted painkilling peptides, similar in function to benzodiazepines (an opioid drug), but—and which is a big difference—confined to the peripheral nervous system (PNS), meaning that it doesn’t enter the brain.

• The peptides killing the pain before it can reach the brain is obviously good because that means the pain is simply not experienced
• The peptides not having any effect on the brain, however, means that the mechanism of addiction of opioids simply does not apply here
• The peptides not having any effect on the brain also means that the CNS can’t be “put to sleep” by these peptides in the same way it can if a high dose of opioids is taken (this is what typically causes death in opioid overdoses; the heart simply beats too slowly to maintain life)

The hope, therefore, is to now create medications that target the spinal ganglia that produce these peptides, to “switch them on” at will.

Obviously, this won’t happen overnight; there will need to be first a lot of research to find a drug that does that (likely this will involve a lot of trial and error and so many mice/rats), and then multiple rounds of testing to ascertain that the drug is safe and effective for humans, before it can then be rolled out commercially.

But, this is still a big breakthrough; there arguably hasn’t been a breakthrough this big in pain research since various opioid-related breakthroughs in the 70s and 80s.

You can see a pop-science article about it here:

Chronic pain, opioids and natural benzos: Researchers discover how body can make its own “sleeping pills”

And you can see the previous research (from earlier this year) that this is now building from, about the glial cells in the spinal ganglia, here:

Peripheral gating of mechanosensation by glial diazepam binding inhibitor

But wait, there’s more!

Remember what we said about affecting the PNS without affecting the CNS, to kill the pain without killing the brain?

More researchers are already approaching the same idea to deal with the same problem, but from the angle of gene therapy, and have already had some very promising results with mice:

Structure-guided design of a peripherally restricted chemogenetic system

…which you can read about in pop-science terms (with diagrams!) here:

New gene therapy could alleviate chronic pain, researchers find

While you’re waiting…

In the meantime, approaches that are already available include:

• The 7 Approaches To Pain Management
• Managing Chronic Pain (Realistically!)
• Science-Based Alternative Pain Relief ← when painkillers aren’t helping, these things might!

Take care!