Constant Pain; Personalized Drugs May Be Ready Soon

The Washington Times (Washington, DC), August 10, 2004 | Go to article overview

Constant Pain; Personalized Drugs May Be Ready Soon


Byline: Christian Toto, THE WASHINGTON TIMES

Angela Yancey knows all about searing pain. It has been her steady companion for the last quarter century.

The 43-year-old Upper Marlboro resident first felt discomfort in her shoulder at age 17 and it hasn't let up since.

She recently found some relief through a series of Botox injections, a treatment typically reserved for smoothing aging skin, but her story highlights the ongoing struggle many chronic pain sufferers endure.

The body feels pain when cells release a chemical called prostaglandin after being injured or disrupted. The nerves around the cells detect the chemical and alert the brain that an injury has occurred.

Pain relievers like ibuprofen prevent cells from making and releasing that chemical, thereby preventing the potential pain sensation.

Stronger drugs such as Vicodin work directly with the spinal cord to block the pain receptors at the source. These drugs treat pain that isn't as responsive to anti-inflammatory agents.

They have their own side effects, including a positive rush that can lead to psychological addiction. The more powerful drugs typically are prescribed after surgery or to treat acute pain.

Ms. Yancey says for years doctors told her the pain she suffered was all in her head. To this day, specialists haven't pinpointed the exact cause, though she suffers from degenerative arthritis, bulging discs and fibromyalgia, which could contribute to her pain.

Through the years she tried every medication imaginable and even endured trigger point injections, which administer medication directly into the source of the pain.

"At one point my purse was like a pharmacy," she says.

The pain worsened three years ago, and none of the procedures or medications that previously offered a modicum of relief could help her.

Dr. Lee Ann Rhodes, a pain management expert with the Washington Hospital Center in Northwest, began injecting her shoulders with Botox.

"I feel like I've gotten my life back," says Ms. Yancey, who receives injections in both shoulders every four months and keeps a home traction unit and electrical stimulation kit at home for when the pain is intense. "When you suffer from this kind of pain, it does make you depressed. You're extremely fatigued all the time."

Dr. Rhodes says researchers still have plenty to learn about pain and the best ways to treat it.

"Two people with the exact same injury can experience pain differently. It's an individualized condition. You have some people who stay in bed all day while others go out and go to work."

A pain specialist's work isn't made easier by the array of pain types to deal with, from acute to chronic, whether inspired by cancer, diabetes or conditions such as shingles.

She says another branch of medications, those typically reserved to treat depression, also work on pain by targeting the neurological pathways the pain messages are sent along. These drugs can have side effects and they may take weeks to work.

Some pain has no actual root or cause. Phantom pain can be "felt" by patients who have endured an amputation. In some cases, nerves formerly connected to the limb in question have been pulled free from the spinal cord, which makes them still active despite the fact that no injured tissue is connected to it.

Dr. Christopher Spevak, a clinical associate professor of anesthesiology at Georgetown University, says the treatment of pain has "advanced significantly" over the years as the understanding of the mechanisms and origins of pain has grown. …

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