What’s on the Horizon?
The FDA recently approved Strontium-89, a nonopioid therapy indicated for the treatment of painful skeletal metastases caused by cancer. The product is administered intravenously once every 3 months as an alternative to opioid analgesics and plays a critical role in the treatment of metastatic bone pain.7
Medical cannabis is still “the wild, wild west,” according to Dr D’Olimpio, who had done over 1000 certifications for it (cancer and chronic pain are qualifying conditions of use in New York State). His team has developed matching algorithms for which type of pain does best with certain proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) and what works best for anxiety or polysymptomology, like nausea and poor appetite. Close patient monitoring and follow up is a must, as it is with opioids.
More recently, he said, research into palmitoylethanolamide (PEA) a natural fatty acid found in nuts and vegetables, seems promising.8 It’s been touted as a pain-reducing medical food in Europe. Dr D’Olimpio said he is looking into it as an objective treatment that’s completely devoid of side effects.
Dr Sinha and colleagues called for increased research into the biology of pain and faster development of new treatments.1 They also want policymakers to increase National Institutes of Health (NIH) research funding to develop novel modalities and pay more attention to advancing innovative treatment approaches.
While NIH remains underfunded, there are signs that research may be ramping up. Harvard Medical School’s Program in Therapeutic Science (HiTS, for which Dr Sinha is affiliated) has begun exploring one promising approach — a project called STOP PAIN, which stands for Safe Therapeutic Options for Pain and Inflammation — with the support from US Defense Advanced Research Projects Agency (DARPA).9
- Hwang TJ, Sinha MS, Dave CV, Kesselheim AS. Prescription opioid epidemic and trends in the clinical development of new pain medications. Mayo Clin Proc. 2019;94(12):2437-2443.
- The National Academy of Sciences. Consensus study report highlights. Framing opioid prescribing guidelines for acute pain: Developing the evidence. Published December 2019. Accessed March 2, 2020.
- Ulker E, Del Fabbro E. Best practices in the management of nonmedical opioid use in patients with cancer-related pain [published online December 24, 2019]. Oncologist. doi: 10.1634/theoncologist.2019-0540
- US Department of Health and Human Services. Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Published May 9, 2019. Accessed March 2, 2020.
- Simon S. American Cancer Society. ACS report: Number of US cancer survivors expected to exceed 20 million by 2026. Published June 2, 2016. Accessed March 2, 2020.
- Akkaya N, Atalay NS, Selcuk ST, Alkan H, Catalbas N, Sahin F. Frequency of fibromyalgia syndrome in breast cancer patients. Int J Clin Oncol. 2013;18(2):285-292.
- P&T Community. Patients seek non-opioid options for cancer pain management. Published November 20, 2019. Accessed March 2, 2020.
- Hesselink JM. Evolution in pharmacologic thinking around the natural analgesic palmitoylethanolamide: from nonspecific resistance to PPAR-α agonist and effective nutraceutical. J Pain Res. 2013;6:625-634.
- Jiang K. Harvard Medical School. Stopping pain [news release]. Published December 2, 2019. Accessed March 2, 2020.