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Doctors take longer than the devil’s bargain: relieving severe pain, such as that caused by surgery and traumatic injuries. The risk of causing happiness in a way that may cause patients to become addicted to drugs. Opium is one of, if not the most powerful of all. at The most powerful painkiller ever known. But for many years these drugs have been the cause of alarming illness and death. After the Civil War Thousands of veterans also became addicted to drugs Morphine and opium, which are used to treat combat injuries and illnesses, in the 1990s, overdoses by doctors along with aggressive and deceptive drug marketing by pharmaceutical companies This has led to a serious and ongoing opioid epidemic. It has killed more than 800,000 Americans.
The Devil’s Bargain has severely shaped the practice of medicine in America in the 21st century. Since the beginning of the opioid epidemic, doctors have cut down severely over the amount of opiates they prescribed This means that some patients who truly need pain relief often go untreated or not at all. Although estimates vary, in 2018 Analysis It has been found that approximately 5 percent of people who are prescribed opioid painkillers will develop dependence. For many doctors, alleviating the suffering of some patients isn’t worth the risk of saddled with potentially deadly drugs.
New research published today at scientific progressIt shows that it is indeed possible to use opiates to relieve physical suffering without the risk of addiction. In this study A team of researchers led by neuroscientists Francis Lee of Weill Cornell Medicine and Anjali Rajadhyaksha of the Lewis Katz School of Medicine at Temple University blocked the rewarding properties of opium in rats. while still maintaining the analgesic effect of the drug (I am a clinical psychiatrist at Weill Cornell and Lee is chair of the department of psychiatry. But we have never collaborated on research.) These findings are preliminary. But it can fundamentally change the paradigm of pain. They provide an opportunity for doctors and researchers to seriously consider a future in which pain and pleasure can be separated and controlled independently.
The new study focuses on a class of drugs called MAGL inhibitors, which increase levels of endocannabinoid Also known as 2-AG in the brain, endocannabinoids are cannabis-like molecules that bind to the same brain receptors that the THC in marijuana does, but they provide a more powerful response. In one experiment Some rats were given a MAGL inhibitor, while others were assigned to a control group. All rats were given the opportunity to self-administer a dose of powerful opiate. What surprised the researchers was that Mice given MAGL inhibitors showed less interest in opiates. Meanwhile, rats given MAGL inhibitors were less attracted to opioids. in separate tests When heat is applied to the tail of a rat (Mild painful stimulus) People who received MAGL inhibitors did not wince any more than those who received opiates alone. In other words, MAGL inhibitors appear to reduce the effects of opiates. while maintaining its analgesic benefits.
Psychiatrists have assumed for some time that opiates and endocannabinoids (if present) should enhance each other’s pleasurable effects. Because both have receptors in the brain’s reward pathways, Lee and Rajadhyaksha’s team found that when 2-AG binds to its receptors in the brain’s reward pathways, It inhibits the release of dopamine. This will reduce the reward that opium will give. Meanwhile The analgesic effects of opium are also unimpeded by the body. pain cycleThere are only a few receptors that 2-AG can bind to.
A neuroscientist I spoke with who was not involved in the study told me these findings. The study (if confirmed in future research) has the potential to meaningfully change pain medicine. Eric J. Nestler, professor of neuroscience at the Icahn School of Medicine at Mount Sinai, called the study that It is a “new and exciting approach” to dissecting the addictive and pain-killing properties of opiates. He also points out that based on preliminary research, MAGL inhibitors appear to cause only minor side effects. humansuch as mild sedation and dizziness. “The real proof will be in humans,” Nestler told me. Matthew Hill, a neuroscientist and cannabis expert at the University of Calgary in Canada, is optimistic about the prospects for such proof. “The exciting thing is When it comes to the endocannabinoid system A lot of what we learn from animal models translates quite well to humans,” he told me.
The clearest implication of this new study is that If replicated in humans, MAGL inhibitors could help reduce the opioid epidemic. Imagine after surgery or a serious injury. You can leave the hospital with a bottle of pills containing Percocet and a MAGL inhibitor. The pills can feel As neutral as Advil or Tylenol, although it is a much stronger painkiller, MAGL inhibitors may be useful in treating people who are already addicted to opiates. Currently, the standard of care is to manage patients’ withdrawal symptoms with drugs such as meth. Tadone and Buprenorphine It is an opiate and maintains a euphoric state and the potential for abuse. Adding a MAGL inhibitor to the mix may make methadone and buprenorphine safer to use.
The medical world must contend with a kind of pharmacological Calvinism. That’s the idea that if something feels good, That must be detrimental to you. That assumption makes some health care providers exaggerate Risk of addiction to drugs such as Valium and Klonopin. which is used to treat anxiety symptoms above all else Similar legends abound in American culture. They often present pain relief and pleasure as mutually exclusive physical and mental experiences—different sides of the same coin. For example, many advertisements for painkillers or muscle relaxants depict people who are not It only relieves the pain. But we also magically returned to some happiness, such as playing sports or enjoying nature. mental distress including those caused by pain It is often thought to facilitate personal growth. And as any trainer will tell you: no pain, no gain.
But the more scientists study pain and pleasure, the more Their findings will only further test existing assumptions about psychology and philosophy. Since the 1950s, researchers have understood that the neural circuits that produce pleasure and pain are largely different. Even though these circuits are close to each other and interact with each other, If you have ever been seriously injured in an accident You may experience self-isolation: your pain is temporarily controlled by endorphins. which is a pain reliever in the brain But chances are, you won’t feel euphoric. Other recent advances may expand the range of non-addictive pain relievers, for example, earlier this year. Drug maker Vertex Pharmaceuticals It has filed an FDA application for a drug that blocks pain signals in peripheral nerves before they reach the brain. This is because happiness is an experience that occurs in the central nervous system. The drug therefore has little potential for abuse. If further research supports Vertex’s existing results, this would be a major advance in treating pain caused by things like broken bones, but the drug tends to leave deep internal pain untouched.
If Lee and Rajadhyaksha’s new study is replicated in humans, It will have a profound impact. It doesn’t just affect how doctors treat pain. but also the way we all think about the nature of pain. I hope doctors will be more considerate in providing pain relief if they can confidently forestall or prevent the risk of addiction. And understanding that happiness and pain relief don’t have to be connected at the hip might help the rest of us be less moralistic about our daily misery. Chronic pain is a leading cause of disability. Interfering with healthy behaviors such as exercising and may even shorten your lifespan slightly. Service life– Why don’t you keep it?
For too long, doctors have been afraid of pain relief. while the patient suffers from severe discomfort or is at risk of addiction. Researchers now have an opportunity to reassess the risk-benefit calculus of pain. It is very beneficial that medicine has a new generation of drugs that can eliminate our pain and leave the task of finding happiness to us.
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