DOCTORS SEEK PAIN RELIEF WITH LESS ADDICTION

Doctors Look For Way To Get A Handle On Pain Medications, Ease Patient
Fears

Washington - Scientists are hunting new ways to help millions of pain
sufferers - from addiction-resistant narcotics to using brain scanners
for biofeedback - amid a worrisome rise in abuse of prescription
painkillers.

The good news: Only a tiny fraction of patients who appropriately are
prescribed the most powerful painkillers - drugs known as opioids,
including morphine, Vicodin, fentanyl and Oxycontin - become dependent
on them.

And scientists told the National Institutes of Health recently that
those few who are vulnerable tend also to suffer such psychiatric
disorders as depression and anxiety, giving doctors a clue about which
patients need closer monitoring.

Opioids "are not dangerous if you know how to use them properly," said
Nora Volkow, chief of NIH's National Institute on Drug Abuse.

Amid fears that rising painkiller abuse will spark a backlash against
pain sufferers, Volkow organized a two-day meeting involving several
hundred scientists and primary care physicians to bring the latest
science on pain and addiction to doctors struggling to balance the
drugs' clear benefits and potential harm.

Chronic pain affects one of every three or four adults worldwide. The
government says one in 10 Americans suffers pain that lasts a year or
more.

For millions, pain is severe enough to be disabling; up to 6 million
patients are on long-term opioid therapy.

It's not just a question of suffering: Serious pain actually can
worsen recovery from various ailments.

How many need opioids but don't get them?

Those numbers are hard to come by, but "pain is really under-treated
in our society," opioid specialist Christopher Evans of the University
of California, Los Angeles.

By some estimates, as many as 40% of cancer patients and the
terminally ill don't get those medications.

At the same time, prescription drug abuse, particularly of opioids, is
on the rise.

One in 10 high school seniors admits to popping Vicodin for
non-medical purposes, and recent studies suggest about 2.2 million
people age 12 and older first abused painkillers in the past year,
outpacing new marijuana users.

Some 415,000 people received treatment for painkiller abuse last
year.

So the hunt is on for pain relief that minimizes the abuse risk - not
just for the 2% of pain patients who might become dependent, but to
discourage theft or other diversions.

Under research now:

. Pain Therapeutics Inc.'s Remoxy is in late-stage clinical trials to
see if it offers an abuse-resistant version of oxycodone, the
ingredient in Oxycontin. Oxycontin tablets are supposed to slowly
dissolve for long-term pain relief, but abusers crush them and snort
or inject the powder for a fast high. Remoxy is a thick gelatin
version of oxycodone - crushing it just yields goo.

. Also being studied is a combination of naltrexone, a drug used to
reduce alcohol craving, with oxycodone. The extra drug should tamp
down oxycodone's brain-stimulating effect, but one question is whether
that also will diminish pain relief.

. Another approach in early trials pairs technology with tiny tablets
of a hospital-strength opioid, sufentanil, redesigned to dissolve
almost instantly under the tongue. A computerized dispenser, the size
of a remote control, is programmed with the patient's dose of Nanotabs
and records how much is used and how often, information the doctor
would require before allowing refills or adjusting doses.

Then there's the non-drug approach: Omneuron Inc. and Stanford
University researchers are trying to teach patients to control how
much pain they feel by scanning their brains and showing them the
real-time MRI images as they try different techniques.

"The brain is built to be able to modulate its pain-control
processes," says Omneuron chief executive Christopher deCharms. "We're
teaching people to gain conscious control."