New approaches to pain management

  • The Role of Novel Analgesics and Monitors to Assess Pain (PN118)
  • 4-5 p.m. Saturday
  • BCEC Room 205AB

New classes of opioids, combinations of long-acting local anesthetics and analgesics, and pain monitors are being used to improve pain management. They will be examined in three presentations during a Saturday education session.

Although these approaches could improve pain management, novel opioids stand out because of the growing abuse of the drug. Two classes of opioids feature fewer side effects, including reduced addiction potential. The FDA may soon review them for approval.

T.J. Gan, M.D., M.B.A.

For example, oliceridine, an opioid modulator, acts on G protein-coupled receptors using different pathways. Its phase III trial was recently completed, and the manufacturer has filed for FDA approval of the drug, said T.J. Gan, M.D., M.B.A. Dr. Gan will present “Opioid Modulators and Kappa Opioids.”

“While it relieves pain like traditional opioids, it has different pathways. One is the beta arrestin pathway, which modulates opiate side effects,” said Dr. Gan, Professor and Chairman of the Department of Anesthesiology at Stony Brook University, Stony Brook, New York.

A second new drug is the kappa opioid CR845, which is still in phase III trials. This class of opioids acts on kappa receptors while traditional opioids act on mu receptors.

“Because they do not act on the mu receptors, kappa opioids produce less nausea, vomiting and itching, and potentially a lower potential for abuse,” Dr. Gan said.

Long-acting local anesthetics

Local anesthetics typically last four to six hours, but novel formulations can last up to 72 hours. One formulation is liposomal bupivacaine, but other similar products are now in phase III trials. Those new products and the potential of long-acting local anesthetics used in combination with analgesics will be examined.

HTX-011 is a product that combines a local anesthetic with NSAIDs. Another novel product is a bupivacaine collagen-matrix implant that can be applied to the abdomen lining during surgery, Dr. Gan said.

“What is interesting about this class of long-acting local anesthetics is that instead of giving patients an infusion pump to go home, you use a one-shot injection that lasts from 24 to 72 hours,” he said. “It would be an advantage to better control the patient’s pain, and they would not have an infusion pump to deal with when they leave the hospital.”

Pain monitors

Two monitors to objectively assess pain are available for use in the United States, and a third monitor is in development. The monitors use various algorithms based on EEGs and sympathetic response to assess the degree of nociception. A presentation will examine the potential of monitors to reduce the amount of pain medication used.

“If we had an objective way to measure nociception, we could potentially optimize the dose of opioids in patients who are asleep,” Dr. Gan said. “That would be a novel way to manage patients and potentially reduce the amount of opioids we need.”

A key to using pain monitors is to conduct studies to better understand the correlation between nociception and pain, a subjective experience in conscious patients, he said.

“We are trying to study the clinical utility of the monitor — the advantage of using the monitor versus not using the monitor and the cost-benefit ratio,” Dr. Gan said.

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