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This summary paper in The Lancet surveys the challenges and best practices currently directing the treatment of chronic pain. Chronic pain exerts an enormous personal and economic burden, affecting more than 30% of people worldwide according to some studies. Unlike acute pain, which carries survival value, chronic pain might be best considered to be a disease, with treatment (eg, to be active despite the pain) and psychological (eg, pain acceptance and optimism as goals) implications. Pain can be categorised as nociceptive (from tissue injury), neuropathic (from nerve injury), or nociplastic (from a sensitised nervous system), all of which affect work-up and treatment decisions at every level; however, in practice there is considerable overlap in the different types of pain mechanisms within and between patients, so many experts consider pain classification as a continuum.

Long a scourge on the East Coast, fentanyl is now driving a rapid increase in overdose deaths in the Western U.S. In the Seattle area, overdose deaths involving fentanyl were up 57% in 2020 over the previous year, according to data from the county medical examiner. Preliminary data show deaths from synthetic opioids like fentanyl rose 162% in the Las Vegas area last year. In Los Angeles County, a recent report blamed fentanyl for a 26% jump in overdose deaths among the homeless population during the first seven months of 2020. The problem is particularly acute in San Francisco, where a record 708 people died of drug overdoses in 2020, a 61% increase from the previous year. By comparison, 254 people died of Covid-19 in the city last year.

The National Pain Advocacy Center (NPAC) is a 501(c)(3) non-profit led by Kate Nicholson, a pain sufferer and civil rights attorney, who emerged as a patient advocate in 2017 with an inspirational TedTalk that explained how opioids helped her walk again after a botched surgery.

Expanesthetics congratulates our Davis-based colleagues at EicOsis on their successful completion of their Phase 1a single-ascending dose clinical trial of EC5026.

The opioid crisis is a major public health issue, as more than 1.2 million individuals in the US are reported to have opioid use disorder, while the number of overdose-related deaths reached over 47,000 in 2017. Overall, the total economic burden of the opioid crisis in the United States in 2019 was projected to be approaching $200 billion. This epidemic is in stark contrast to the fact that more than 50 million adults (20.4%) in the US are living with chronic pain, including nearly 20 million individuals dealing with high impact chronic pain (persistent pain that reduces life or work activities). As a result of this dichotomy, the FDA has challenged the biopharmaceutical industry to accelerate development of non-opioid analgesics, along with abuse-deterrent opioid formulations and/or solid dosage forms.