While few new pain medicines have been developed in the past 30 years, promising novel treatments are currently in the works. We had the pleasure of chatting with Professor Maree Smith, a researcher at the University of Queensland who is involved in basic pain research and novel analgesic (painkiller) discovery. She shared with us about her 33 years of work in the chronic pain field and some of the promising new pain treatment options being researched now.
The current state of pain medicine
It can be frustrating for individuals with chronic pain to know that little has changed in terms of pain medicine options over the past 30 years. In fact, very few new analgesics have made it through to clinical approval for doctors to prescribe in the last three decades. Professor Maree acknowledges that there are obstacles which have held back pain medicine development, including gaps in understanding of pain processes in the body.
“Despite vast investment into basic science research targeted at clarifying chronic pain mechanisms, we still don’t have complete knowledge on how exactly pain processes work in the body,” Professor Maree said.
Failure in clinical trials is another obstacle. For example, some medicines that had shown potential in trials with mice turned out to be ineffective in humans due to differences in pain mechanisms between rodents and people.
Perhaps one of the greatest obstacles is the extensive amount of time it takes for trials to reach phase 2a, when medicines are tested in patients for the first time. Professor Maree shares that it often takes 15+ years and an arduous process to reach this phase of clinical trials.
“People are essentially required to commit their career to attempting to discover and develop new patient medicines because of the amount of time it takes to complete clinical trials. It’s such a long journey,” Professor Maree said.
Professor Maree’s passion for pain management
For Professor Maree, witnessing the experiences of some family members with chronic pain and how poorly their pain was alleviated ignited her passion for pain management research. Though she had originally trained and completed her PhD in pharmacology, this passion later motivated her to pursue a postdoc in the pain field.
“I saw how much chronic pain impacts people’s lives and can limit their careers, while simultaneously very few effective pain management medicines existed. This drew me to the pain field,” Professor Maree said.
Professor Maree completed her postdoc under the late Professor Tess Cramond, who had started the first multidisciplinary pain centre in Queensland, the second such centre in Australia.
“Connecting with Professor Cramond was a pivotal step in my career. I soaked up her wisdom and clinical knowledge of managing pain that she had accumulated throughout her career,” Professor Maree said.
These days, in addition to her research work, Professor Maree has an important role in training the next generation of pain researchers. Over the course of her career, she has supervised 33 PhD students and more than 50 honours students working in the pain field.
The limitations of medicines currently used for chronic pain
Unfortunately, current medicines prescribed for chronic pain management may not be effective or they may produce dose-limiting side-effects. A factor contributing to this situation is that for nerve (neuropathic) pain, most medicines used to manage this type of pain were originally developed to treat other health conditions. For example, Professor Maree says that “the main medicines used for treating nerve pain were discovered essentially by serendipity during clinical use. When clinicians observed people taking certain medicines to treat epilepsy or depression, they noticed that these medications also provided some nerve pain relief,” Professor Maree said.
The latest research in medicine for chronic pain
Today, the quest to discover better pain medicine options is ongoing. Professor Maree shares that there has been a lot of research aimed at unravelling neuropathic pain. In her own career she discovered a new experimental medicine called EMA401 that effectively reduced long term post shingles pain in a 4-week trial with patients. This was a hopeful result, but unfortunately the medicine was shown to cause liver toxicity in a subsequent long term study undertaken in primates. It is important to note that none of the humans in a 13-week study that was underway at that time, experienced any liver toxicity. Nonetheless, the whole program was terminated in 2019 due to the risk.
Despite the cancellation of the program, Professor Maree emphasises that it had been valuable in proving that targeting a certain protein in the body called the AT2 receptor could reduce neuropathic pain. Since then, Belgian biotech company Confo Therapeutics has been doing research targeting the same AT2 receptor with their own medicines. The company is now conducting phase 1 trials of its medicine in healthy people and is expected to move to patient trials in 2024 or 2025. Researchers hope the medicine will be effective and have minimal side effects.
Elsewhere in the world, other researchers are investigating whether targeting different proteins can safely and effectively reduce chronic pain. For example, Professor Maree recently heard Professor Ted Price from the University of Texas speak at the Australian Pain Society conference about some medicines he is researching for chronic pain that will be heading to clinical trials soon.
Professor Maree made it clear that Professor Ted Price and the researchers at Confo Therapeutics are not the only individuals working to find better pain medicines. “There are a broad array of people across the globe who are all trying to contribute to making a difference in the pain field,” Professor Maree said.
Professor Maree’s advice for those who feel a lack of hope in finding treatments to improve quality of life despite pain
Professor Maree acknowledges that pain medicine is just one small aspect of treating chronic pain. The most effective pain management plans do not only rely on medicines, but instead take a holistic approach based on the biopsychosocial model of managing pain. She explains that multidisciplinary pain centres are a good place for chronic pain patients to access a range of expertises that provide a well-rounded support experience.
“It’s helpful to learn about pain and identify strategies to manage it using tools beyond just medicine. Multidisciplinary pain centres use a whole range of strategies including psychological support, physiotherapy, occupational therapy, yoga, mindfulness, etc. to help each person. All these ways of modulating pain have good evidence in clinical trials,” Professor Maree said.
Before ending our conversation, Professor Maree wanted to share one final thought on behalf of those who work in the pain field to impart hope to people living with chronic pain:
“Those of us working in the chronic pain field have patients’ best outcomes at heart. Our overall goal is to improve people’s quality of life, and we are each using our individual expertise to do our best to contribute to this aim,” Professor Maree said.
