Anthony DiTullio would pop a painkiller in his mouth but not just swallow it, as intended. He would chew it for 30 minutes, grinding through its protective coating and waxy unpleasantness, because the only pain he was treating was addiction.
The pill was OxyContin, a painkiller that its manufacturer, Purdue Pharma, says deters abuse by being difficult to chew or liquefy into forms that give addicts stronger highs, orally or through injection. Since adding these features to its original and widely abused OxyContin in 2010, the company has likened the pill to a virtual seatbelt to restrain the nation's epidemic of prescription drug abuse.
But as thousands of addicts still find ways to abuse OxyContin and similar painkillers, called abuse-deterrent formulations, some experts caution that the protections are misunderstood and could mislead both users and prescribers into thinking that the underlying medications are less addictive.
Because abuse-deterrent formulations are relatively new, preliminary data on their public-health implications is limited. Several studies, somesponsored by Purdue, have found that abuse of OxyContin specifically has decreased after its protections were added. Other reports confirmed those findings but also found that many abusers simply moved on to other opioids, as well as heroin, leaving the overall effect on drug abuse open for debate.
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http://www.nytimes.com/2015/06/07/us/painkillers-resist-abuse-but-experts-still-worry.html?
The Future of Epigenetics in Pain Research | Pain Research Forum
Epigenetic mechanisms impact gene function without affecting the underlying DNA sequence, and are one way in which the environment can have long-lasting effects on the genome. Epigenetics has been slow to catch on in the pain field compared to many other branches of science and medicine, but that may be about to change. Emerging research is beginning to show how epigenetics can help explain why particular individuals are more vulnerable to chronic pain than others, reveal the mechanisms underlying the transition from acute to chronic pain, and identify new targets for pain therapeutics. So argued co-presenters Stephen McMahon and Franziska Denk, King's College London, UK, in a PRF webinar titled Pain Epigenetics: Current Research and Future Challenges, which took place on April 16. The talk was followed by a panel discussion with Chas Bountra, University of Oxford, UK, and Santina Chiechio, University of Catania, Italy. Laura Stone, McGill University, Montreal, Canada, moderated the event.
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Former Players: NFL Teams ‘Conspired’ To Push Painkillers « CBS Miami
The theory that painkillers were pushed to NFL players to keep them on the field has has circulated for years.
Now hundreds of former players are bringing the issue to court after they filed a lawsuit claiming all 32 NFL teams, their doctors, trainers and medical staffs often illegally obtained and provided painkillers to players.
The lawsuit reprises some of the allegations made in a federal lawsuit last year on behalf of 1,300 former players against the NFL. That complaint was filed in May, 2014 and dismissed in December by Judge William Alsup of the U.S. Northern District in California. Alsup wrote that the collective bargaining agreement between the league and the NFL Players Association was the appropriate forum to resolve such claims. That decision is being appealed.
The new lawsuit was filed Thursday in the U.S. Northern District of Maryland. It names each NFL team individually as a defendant and lists 13 plaintiffs, including Hall of Fame cornerback Mel Renfro of the Dallas Cowboys and Etopia Evans, the widow of Charles Evans, a running back who played eight years with the Minnesota Vikings and the Baltimore Ravens and retired after the 2000 season. Evans died of heart failure in October 2008 at age 41.
"This lawsuit alleges intentional activity by the teams, not negligence," said plaintiffs' attorney Steve Silverman. "It's another part of a unified effort to provide health care and compensation to the thousands of former players who have been permanently injured or died as a result of playing professional football."
Both lawsuits contend NFL teams and their medical staffs withheld information from players about the nature and seriousness of their injuries, while at the same time handing out prescription painkillers, anti-inflammatories and other dangerous drugs to mask pain and minimize lost playing time. Among other claims, the players contend prescriptions were filled out in their names without their knowledge.
The new lawsuit also claims that several former head coaches and assistants — among them, Don Shula, Howard Schnellenberger, Wayne Fontes, Mike Holmgren and Mike Tice — warned players they would be cut from their teams unless they took painkillers and returned to the field.
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http://miami.cbslocal.com/2015/05/21/former-players-nfl-teams-conspired-to-push-painkillers/
Now hundreds of former players are bringing the issue to court after they filed a lawsuit claiming all 32 NFL teams, their doctors, trainers and medical staffs often illegally obtained and provided painkillers to players.
The lawsuit reprises some of the allegations made in a federal lawsuit last year on behalf of 1,300 former players against the NFL. That complaint was filed in May, 2014 and dismissed in December by Judge William Alsup of the U.S. Northern District in California. Alsup wrote that the collective bargaining agreement between the league and the NFL Players Association was the appropriate forum to resolve such claims. That decision is being appealed.
The new lawsuit was filed Thursday in the U.S. Northern District of Maryland. It names each NFL team individually as a defendant and lists 13 plaintiffs, including Hall of Fame cornerback Mel Renfro of the Dallas Cowboys and Etopia Evans, the widow of Charles Evans, a running back who played eight years with the Minnesota Vikings and the Baltimore Ravens and retired after the 2000 season. Evans died of heart failure in October 2008 at age 41.
"This lawsuit alleges intentional activity by the teams, not negligence," said plaintiffs' attorney Steve Silverman. "It's another part of a unified effort to provide health care and compensation to the thousands of former players who have been permanently injured or died as a result of playing professional football."
Both lawsuits contend NFL teams and their medical staffs withheld information from players about the nature and seriousness of their injuries, while at the same time handing out prescription painkillers, anti-inflammatories and other dangerous drugs to mask pain and minimize lost playing time. Among other claims, the players contend prescriptions were filled out in their names without their knowledge.
The new lawsuit also claims that several former head coaches and assistants — among them, Don Shula, Howard Schnellenberger, Wayne Fontes, Mike Holmgren and Mike Tice — warned players they would be cut from their teams unless they took painkillers and returned to the field.
More ...
http://miami.cbslocal.com/2015/05/21/former-players-nfl-teams-conspired-to-push-painkillers/
Solicitation of Public Comments on Draft National Pain Strategy - The Interagency Pain Research Coordinating Committee (IPRC)
A core recommendation of the 2011 IOM Report: Relieving Pain in America 
is: "The Secretary of the Department of Health and Human Services should develop a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, time frames, and resources." The IOM report highlighted specific objectives for the strategy:
is: "The Secretary of the Department of Health and Human Services should develop a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, time frames, and resources." The IOM report highlighted specific objectives for the strategy:- Describe how efforts across government agencies, including public–private partnerships, can be established, coordinated, and integrated to encourage population-focused research, education, communication, and community-wide approaches that can help reduce pain and its consequences and remediate disparities in the experience of pain among subgroups of Americans.
- Include an agenda for developing physiological, clinical, behavioral, psychological, outcomes, and health services research and appropriate links across these domains.
- Improve pain assessment and management programs within the service delivery and financing programs of the federal government.
- Proceed in cooperation with the Interagency Pain Research Coordinating Committee and the National Institutes of Health's Pain Consortium and reach out to private-sector participants as appropriate.
- Involve the appropriate agencies and entities.
- Include ongoing efforts to enhance public awareness about the nature of chronic pain and the role of self-care in its management.
The Department of Health and Human Services charged the Interagency Pain Research Coordinating Committee (IPRCC) with creating a comprehensive population health-level strategy to begin addressing these objectives.
***
National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain (draft)
http://iprcc.nih.gov/docs/DraftHHSNationalPainStrategy.pdf
Preoperative Efficiency of Conditioned Pain Modulation in Rats Predicts Recovery From Pain After Surgery | Pain Research Forum
Rats with weak conditioned pain modulation (CPM), a measure of endogenous analgesia, experience longer recovery times from mechanical hypersensitivity following surgery compared to rats with stronger CPM, according to a study published in the April issue of Anesthesiology. The research, which is consistent with observations in humans, was led by Christopher Peters, Wake Forest University, Winston-Salem, US, and provides a new method for investigating CPM and postsurgical pain in animals. It also points to one mechanism, noradrenergic signaling, that may be involved in the relationship between CPM and resolution of pain after surgery.
"This is an impressive example of back translation [from humans to animals] in pain research," wrote David Yarnitsky, Rambam Health Care Campus, Haifa, Israel, and Albert Dahan, Leiden University Medical Center, the Netherlands, in an accompanying editorial.
From people to rats
It was Yarnitsky's own clinical work that inspired the current research. Chronic pain following surgery is a major problem that affects at least 10 percent, and possibly as many as 50 percent, of patients who undergo common surgical operations (Kehlet et al., 2006). Suspecting that individual differences in endogenous analgesia may play a role in these adverse outcomes, Yarnitsky has found that patients with lower CPM—lower induction of diffuse analgesia throughout the body following an intense, focal pain stimulus—prior to surgery were more likely to have chronic pain six months after thoracotomy (surgical opening of the chest; Yarnitsky et al., 2008). Preoperative CPM also predicts pain following abdominal surgery (Wilder-Smith et al., 2010).
To further examine the relationship between CPM and postsurgical pain, and to look for mechanisms underlying this association, Peters and colleagues modeled the two phenomena in rats. Overall, the research is an "effort to try to make the studies that we're doing in rodents a little more translatable to humans," said Peters.
To study CPM, the researchers used a paradigm in which capsaicin administered to the forepaw increases hind paw withdrawal thresholds to mechanical stimuli. To model postsurgical pain, the researchers performed partial ligation of the L5 spinal nerve. Nerve injury is a proposed risk factor for developing chronic pain, explained Peters, so "we wanted a model that had a neuropathic component … and that we knew would spontaneously recover," he said. To examine the rats' recovery, the researchers measured mechanical withdrawal thresholds in both hind paws until 70 days post-surgery.
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The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention WorkshopEffectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain | Annals of Internal Medicine
Background: Increases in prescriptions of opioid medications for chronic pain have been accompanied by increases in opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness.
Purpose: To evaluate evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults.
Data Sources: MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO, and CINAHL (January 2008 through August 2014); relevant studies from a prior review; reference lists; and ClinicalTrials.gov.
Study Selection: Randomized trials and observational studies that involved adults with chronic pain who were prescribed long-term opioid therapy and that evaluated opioid therapy versus placebo, no opioid, or nonopioid therapy; different opioid dosing strategies; or risk mitigation strategies.
Data Extraction: Dual extraction and quality assessment.
Data Synthesis: No study of opioid therapy versus no opioid therapy evaluated long-term (>1 year) outcomes related to pain, function, quality of life, opioid abuse, or addiction. Good- and fair-quality observational studies suggest that opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction, although there are few studies for each of these outcomes; for some harms, higher doses are associated with increased risk. Evidence on the effectiveness and harms of different opioid dosing and risk mitigation strategies is limited.
Limitations: Non–English-language articles were excluded, meta-analysis could not be done, and publication bias could not be assessed. No placebo-controlled trials met inclusion criteria, evidence was lacking for many comparisons and outcomes, and observational studies were limited in their ability to address potential confounding.
Conclusion: Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose-dependent risk for serious harms.
Primary Funding Source: Agency for Healthcare Research and Quality.
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