The future of alternative pain therapies


The need to find alternative opioid therapies to treat acute and chronic pain is critical for a number of reasons.

With the aging of the population and individuals living longer, it will be necessary to develop new therapies beneficial to the geriatric population.

In addition, our understanding of the opioid epidemic and the addictive nature of treatment continues to expand.

In an interview with HCPLive®, Tobias Moeller-Bertram, MD, Chief Medical Officer of the Desert Clinic Pain Institute, explained why alternative therapies have been slow to take shape, but how our growing understanding of patients and treatments could lead to positive changes in the near future .

Moeller-Bertram is the co-chair of the Evolving Approaches in Pain Management conference in San Diego on August 14, which will bring together several experts discussing opioid use, alternative options for post-surgical pain, and how best to treat pain. addiction.

HCPLive: Since pain is something that cuts across different medical fields, how important is it to bring together people with different skills to discuss some of these topics?

Moeller-Bertram: It is of the utmost importance. Pain is something that affects all aspects of the human experience. It affects the physical, mental and spiritual aspects.

If you look at the different varieties of specialties that come into the area of ​​pain and can be certified, to see truly experts in anesthesia, focusing more on physiology and blocking pain better with medication than in psychiatry, which is really more focused on the emotional experience of pain and emotion.

You start with the definition of pain which is a physical and emotional experience. And the whole concept of the biopsychosocial experience really shows that pain is the ultimate combination of comprehensive care for the person.

Thus, all specialties that focus on the physical, mental and spiritual aspect of pain are not only welcome but necessary to truly relieve the pain of its origin, but also the burden of pain and suffering that accompanies it. .

A multidisciplinary or transdisciplinary approach is necessary for meaningful treatments.

HCPLive: With the population aging as it is, how important is it to provide alternatives to pain that could help the older population?

Moeller-Bertram: This is a problem that is going to affect many of us and not only the population is living longer, but I think the hope of living meaningful lives is very high. People want to stay active. people want to stay engaged and people want to contribute to society.

Finding a way to increase mobility and quality of life and avoid the risks of current drugs, especially opioids, I think that’s going to be very important.

There are exciting opportunities. We work in close collaboration with our surgical and orthopedic colleagues to try to fight against osteoarthritis. In general, when you look at the new therapies evolving, I think there is some hope that some new therapies will be able to reduce osteoarthritis pain and not have the side effect profiles of opioids.

HCPLive: For cannabis, do we have a good understanding of where it should be used and where it may be less effective?

Moeller-Bertram: I wish I could give you the answer. I think in a few years we will be able to do it. I think we have a good understanding of the utility, I think the evidence so far is convincing enough, that it is shown to be a good product for pain, in general.

I think before we can even determine which specific areas of pain will respond well to cannabis derivatives and treatments, we probably need to understand a little bit about the compounds to watch out for.

Cannabis contains over 100 cannabinoids and there is what is called the entourage effect, where the combination of different components works differently from other components alone.

So I think we need to better understand what in plant matter has what kind of effects.

And once we can explain this a little more, we can see for example that a certain combination is better for reducing inflammation in the body, one would expect that any inflammatory pain would respond well to that combination.

If it’s something that has a more muscle-relaxing combination, one would imagine that a treatment consisting of these components will be better when it comes to musculoskeletal pain.

I think it will be a combination of feedback on the clinical data that we receive from patients who take these drugs, indicating for which pain issues and complaints this has been helpful.

And then, on the other hand, we scientifically understand what compounds and combinations of compounds have an effect on the body, and therefore combining them to hopefully be able to really come up with specific subsets of therapies for specific indications. pain.

HCPLive: Has the pandemic highlighted gaps that need to be addressed in terms of pain management?

Moeller-Bertram: My immediate response would be that I can tell you that a substantial portion of my patients in my clinics have realized that addiction to particularly opioid drugs meant to them.

Go through anxiety and make sure they have access to their meds, which I think wasn’t necessarily on their minds before the pandemic.

Many of them viewed this as negative rather than positive because they were motivated not to rely on a drug that they had to get up from because there were withdrawal syndromes and, of course, increased pain. .

In particular, withdrawal symptoms are something patients did not normally report before the pandemic. So I think this might be something that people think about more, I really want to expose myself to this life scenario. Having regular access to these medications is not only important for me to treat my pain, but also important for me to avoid withdrawals.

How this will translate into a willingness to seek alternatives, or, how much easier it will allow us to have conversations about reducing and limiting opioids will be seen, but at least that’s something that comes to mind initially.

HCPLive: You also present at the Opioid Dependence Treatment Options meeting, how has this area developed in recent years?

Moeller-Bertram: I think this is an area that continues to evolve. And we have options medically and then brought more to the fore, especially the probuphine type of therapy.

The fact that it’s easier for doctors to prescribe than at this point, I think, has had a big impact.

There is always room for improvement.

On the non-pharmacological side, I think accessing trauma-informed care, and really working with drug addicts in those areas is something that I hope we want to improve and increase that.

HCPLive: How difficult is it to balance the addictive nature of some of these substances with their medicinal value?

Moeller-Bertram: I think this is a pervasive problem when it comes to treatment. You want to have a risk / benefit profit profile; you don’t want to put people at unnecessary risk. Additionally, the individual nature of how you respond to a pharmacological compound also plays a role here.

I think we can probably learn more about predictive measures and predict factors that respond to certain drugs.

We don’t like everyone to react the same way when it comes to addictive behavior to certain drugs. But I believe that in medicine we often only think of the average patient, who does not exist.

Some compounds have absolutely higher addictive potential than others and we have a pretty good idea. But I think the predictive metrics in terms of which individual patients are actually taking their medications, there is something we can learn more about, and I hope you can improve that.

So I hope that as doctors and healthcare providers in the future we will have better ways to increase the benefits and reduce the risks when we use therapies that have a benefit for patients but also known issues.

HCPLive: Are we on the verge of achieving the necessary balance in the treatment of chronic and acute pain?

Moeller-Bertram: I hope so. I think this is motivated by the understanding that the simple transition from a works for acute pain applies to chronic pain does not. I think the awareness around this really drives the change in thought process and the change in approach to treatment.

I continue to hope that all of this caring for the person and the idea of ​​really individualizing the treatment will continue, which must mean that we look more at the circumstances, which person has which disease, for what reasons.

I think the trend continues. This is going to take a while, there are a lot of factors involved.

It starts with understanding healthcare professionals, patient acceptance of the paradigm shift, then the insurance apparatus and everything behind reimbursement models and that sort of thing to really adapt. to that.

It will be a process. But I think we’re at the point where we know this, this road has to be walked, we really can’t turn away from it. So I hope that every stakeholder in both stays motivated and, you know, takes this path one step at a time. And maybe next year, when you ask me, you will already have more tangible changes.

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