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As the medical establishment tries to do a huge U-turn after two disastrous decades of pushing long-term opioid use for chronic pain, scientists have been struggling to develop safe, effective alternatives. When naltrexone is used to treat addiction in pill form, it's prescribed at 50 mg, but chronic-pain patients say it helps their pain at doses of less than a tenth of that. Low-dose naltrexone has lurked for years on the fringes of medicine, but its zealous advocates worry that it may be stuck there. Naltrexone, which can be produced generically, is not even manufactured at the low doses that seem to be best for pain patients.

EDITOR'S NOTE: This article demonstrates the importance of a drug maker's ability to charge and market appropriately for a medicine given the high costs, long path, and other challenges associated with regulatory oversight.

Opioid prescribing after minimally invasive surgery (MIS) remains unacceptably high, according to research conducted at the University of California, San Francisco (UCSF). Of nearly 400 MIS patients surveyed, 90% said they were prescribed opioids after surgery, and 13% of these patients asked for a refill as late as three months after the procedure. The study, which was presented at the 2019 annual meeting of the American Society of Regional Anesthesia and Pain Medicine (abstract 7353), demonstrates that despite efforts to tackle opioid prescribing, it remains a problem and can lead to significant hazards for patients. Solmaz Manuel, MD, an assistant clinical professor in the Department of Anesthesiology and Perioperative Care at UCSF, and her colleagues asked 393 adult patients who underwent ambulatory MIS at UCSF over an eight-month period whether they were prescribed opioids for postoperative pain control and whether they were taking them. The most common procedures were hysterectomy, myomectomy, salpingectomy, oophorectomy, diagnostic laparoscopy, hernia repair and cholecystectomy.

Novartis has quietly scrapped further development of olodanrigan for neuropathic pain. The Swiss company acquired the investigational therapy, also known as EMA401, through its US$200 million acquisition of Spinifex Pharmaceuticals in 2015.

Ten of America's largest drug companies are responsible for releasing 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012, according to previously unreleased data obtained by The Washington Post. These companies, including Walgreens, CVS and Walmart, are being sued in federal court by nearly 2,000 cities, towns and counties claiming they plotted to "flood [America] with opioids." Meanwhile, the number of U.S. deaths tied to drug overdoses fell last year for the first time in almost 30 years, according to the CDC.

Physicians treating patients with acute pain should focus on using a multimodal approach that includes medications, nerve blocks, physical therapy and other modalities, according to a federal task force's final report on acute and chronic pain management best practices (PDF) released Thursday. At the same time, doctors treating patients with chronic pain should look to a multidisciplinary approach across various fields. That could include medications, restorative therapies like physical therapy, cognitive therapies and complementary or integrative health.