[HN Gopher] Researchers uncover potential non-opioid treatment f...
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       Researchers uncover potential non-opioid treatment for chronic pain
       in mice
        
       Author : ulrischa
       Score  : 35 points
       Date   : 2024-02-03 19:37 UTC (3 hours ago)
        
 (HTM) web link (news.utexas.edu)
 (TXT) w3m dump (news.utexas.edu)
        
       | dataangel wrote:
       | There are two types of people with chronic pain though:
       | 
       | 1) People with a known condition like specific cancers where
       | chronic pain can be a well understood aspect of the condition.
       | Taking the meds doesn't hide anything you and the doctor aren't
       | already aware of.
       | 
       | 2) People lumped into a bucket diagnosis (IBS, Fibromyalgia, etc)
       | because the docs don't actually know what's wrong. Taking pain
       | meds is the equivalent of dismissing alerts without
       | investigating. Prior to the opioid crisis even well meaning docs
       | were eager to prescribe because it made patients feel better
       | without addressing any underlying cause.
        
         | metalcrow wrote:
         | The metaphor isn't quite right, because in a lot of cases for
         | #2, the docs still are searching for an underlying reason, but
         | there has to be some treatment in the meantime while research
         | is ongoing. It's like dismissing the same alert that is
         | repeatedly popping up. You know about it and are hunting for
         | the reason, but you can't work if it keeps appearing over and
         | over again.
        
         | codingdave wrote:
         | This feels like an over-simplification.
         | 
         | For bucket #1, you still may be covering up new problems. Just
         | because you have reason A for pain doesn't mean reason B won't
         | crop up later. You need to watch for changes and get them
         | checked out, hoping you aren't covering up anything new. For
         | bucket #2, those in that bucket still need to find a way to
         | make their life better. Opioids are not ideal. But living in
         | pain isn't ideal either. I think most people try to find non-
         | opioid medications or coping mechanisms, but at the end of the
         | day you gotta find a way to live your life.
        
         | jki275 wrote:
         | While true, when you live with the kind of pain they're talking
         | about sometime you just need the pain to go away because you
         | can't live your life otherwise. Doesn't mean you ignore the
         | cause but the pain itself is destroying your life.
        
         | r0ze-at-hn wrote:
         | On #2 I have seen low dose naltrexone work really well which is
         | amusing given its counterintuitive nature as an opioid
         | antagonist. This was a fun puzzle to think about.
         | 
         | My current best guess on how it work starts with the fact that
         | when taken in low doses that only last a few hours it results
         | in upregulation of the opioid receptors. A high level pathway
         | you have for pain and turning off the pain would be:
         | 
         | Pain stimulates nociceptors => increased substance P =>
         | increased cytokines, chemokines, etc => increased T-lymphocyte
         | => increased b-endorphins => inhibit substance P
         | 
         | So with LDN less b-endorphins is needed to "turn off the pain"
         | and you now get a shorter pain on / pain off cycle or really a
         | shorter substance P cycle.
         | 
         | It's obvious first use is when the opioid receptors have been
         | down regulated, but it has lots of extra benefits for instance,
         | the immune response is time limited to the necessary duration
         | of pain, reducing the likelihood of autoimmune complications.
         | Additionally, diminished cytokine levels result in less
         | hypothalamic activation, mitigating excessive appetite (not to
         | mention better TRH response). This helps many with fibromyalgia
         | may struggle with weight management. Numerous other secondary
         | effects have been documented over time (last 40ish years),
         | underscoring the multifaceted impact of low-dose naltrexone.
         | 
         | However, I agree that it is crucial to acknowledge that while
         | this can effectively alleviate symptoms, it may also mask
         | underlying issue(s). That could be something as simple as Zinc
         | deficiency (due to diet or genetic predisposition) or more
         | complicated such as classic like EDS.
        
       | loeg wrote:
       | (In mice.)
        
         | dang wrote:
         | Inmiced. Thanks!
        
       | robg wrote:
       | _Now researchers...have identified a molecule that reduces
       | hypersensitivity in trials in mice by binding to a protein they
       | have shown is involved in neuropathic pain._
        
       | lupusreal wrote:
       | Standard OTC doses of ibuprophen combined with acetaminophen (aka
       | paracetamol) is an effective treatment for all but the most
       | severe chronic pain.
        
         | mtreis86 wrote:
         | Ibuprophen is bad for your stomach, acetaminophen is bad for
         | your liver, neither makes a good long term treatment.
         | https://www.ncbi.nlm.nih.gov/books/NBK310269/
         | https://www.ncbi.nlm.nih.gov/books/NBK548162/
        
           | petesergeant wrote:
           | The link you've posted says paracetamol is bad for your liver
           | in overdose and "harmless" at normal low dose
        
         | oooyay wrote:
         | NSAIDs are pretty dangerous on the whole. It's kinda surprising
         | they remain OTC while something like marijuana is schedule 1.
         | This study encapsulates things pretty well:
         | https://pubmed.ncbi.nlm.nih.gov/16086703/
        
         | genocidicbunny wrote:
         | Anecdotally, only for brief pain. For chronic daily pain, they
         | have a high potential of causing stomach and hepatic problems.
         | Sensitivity or allergy to NSAIDs is also not all that uncommon
         | either. Several people I know cannot take any, or prolonged
         | courses of NSAIDs due to their reactions.
        
       | spacephysics wrote:
       | Let's hope they also promise this is non-addictive for years and
       | have little accountability besides a financial slap on the wrist
       | /s
        
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