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Alternative analgesics: New drugs for pain seek to improve on ketamine's benefits

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Danielle Cosgrove didn’t think that the pain in her foot could get any worse. On holiday in Qatar in 2010, Cosgrove had rented an allterrain vehicle (ATV) with a group… Click to show full abstract

Danielle Cosgrove didn’t think that the pain in her foot could get any worse. On holiday in Qatar in 2010, Cosgrove had rented an allterrain vehicle (ATV) with a group of friends and ridden the sand dunes of the Arabian desert. It was a fun afternoon until disaster struck. The ATV rolled over, and Cosgrove’s left foot took the brunt of the impact: it was crushed, with skin shredded and bones sticking out. The ATV was not driveable, and the second-year university student was sprawled helpless in the baking desert sun for hours, waiting for help to arrive. When rescue crews finally brought her to the hospital eight hours later, she thought that she would finally get some relief from the unrelenting pain— but it just grew worse. Not even the strongest opiate medications on the market could take the edge off. In the weeks after her treatment, the pain spread beyond her foot and all over her body. “It felt like my whole body had been dropped in a volcano,” she says. After her doctors had tried every possible therapy to no avail, Cosgrove was diagnosed with a rare, chronic neuro-autoimmune pain disease called complex regional pain syndrome (CRPS). CRPS is described by those afflicted as the worst pain imaginable—more than three times the intensity of childbirth, as measured by the commonly used McGill Pain Questionnaire. A recent study found that nearly threequarters of people with CRPS are at high risk for committing suicide from the intensity and chronicity of the pain1. Cosgrove herself experienced symptoms of depression, but she decided to try something different: the anesthetic-turned-party drug ketamine. Cosgrove says that it was the first medication that provided her with any kind of relief; pain that she had previously quantified as close to an ‘8’ or ‘9’ on a scale of 1–10 was now closer to a ‘4.’ In an experimental setting, ketamine has been used to treat everything from depression to migraines. Now, one of the most promising areas of low-dose ketamine treatment is for people such as Cosgrove, who have CRPS and have not responded to other forms of pain treatment. CRPS is a rare condition that affects 26 out of every 100,000 people. By contrast, chronic neuropathy (pain that results from damage to peripheral nerves) affects up to 30 million people yearly in the US. The market for chronic-pain drugs in the US alone was estimated at more than $13 billion in 2014 and is only expected to rise. More than 240 million prescriptions for opioids were written in 2014, and yet a 2015 analysis revealed that little evidence existed to be able to determine whether these drugs were efficacious when used for longer than 12 weeks2. Moreover, opioids also carry a substantial risk of addiction and overdose: more than one-third of drug-overdoserelated deaths reported in 2013 were a result of pharmaceutical opiates3. Spurred by these statistics, researchers and pharmaceutical companies have renewed their interest in developing nextgeneration painkillers that move away from opiate pathways. Ketamine was one such drug that had shown early success at providing relief for patients with chronic B ra in li gh t/A la m y St oc k P ho to

Keywords: analgesics new; ketamine; alternative analgesics; crps; cosgrove; pain

Journal Title: Nature Medicine
Year Published: 2017

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