Venomous Pain

Remember Wrinkle Venom?

It appeared as a wonder cream against wrinkles a couple of years ago. It was made from a synthetic form of snake venom. I’m sure it’s still around (there’s a jar on my shelf) but it doesn’t seem to create quite the same hype anymore.

A new study suggests that the real thing (yes, real snake venom) may be the next big thing in pain relievers. Good luck, advertising executives!

Researchers say certain compounds isolated from the venom of the deadly black mamba snake are actually potent painkillers. The black mamba snake is Africa’s longest venomous snake and grows up to 14 feet in length. Its aggressive nature and lethal venom has given it a reputation as the world’s deadliest snake.

In the study, these compounds produced pain relief as strong as morphine in mice, without the unwanted side effects associated with opioid pain relievers.

It’s too early to say whether the same will hold true in humans – but keep an eye out, people!

But researchers say the results suggest the snake venom compounds relieve pain by targeting a different pain pathway in the brain. And that could eventually lead to a new generation of pain killers for people, which is something we (FM sufferers) are definitely searching for.

“It is essential to understand pain better to develop new analgesics,” researcher Sylvie Diochot of the Institut de Pharmacologie Mole ́culaire et Cellulaire, in Valbonne, France, and colleagues write in Nature. The black mamba findings, she says, help with both of those goals.

Previous studies have shown that compounds in snake venom can cause pain by activating what’s called specific acid-sensing ion channels (ASICs).

In this study, researchers found that a newly discovered class of compounds in black mamba snake venom called mambalgins can relieve pain by targeting and blocking these channels. Their experiments in mice show the mambalgins are not toxic and have fewer side effects than traditional pain killers like morphine.

Researchers say their results should lead to a better understanding of pain and introduce natural compounds that may lead to the development of new painkillers.

We’re ready for better pain relief!

Looking for a Silver Lining…

So, I had to go hat-in-hand to see my pain management doctor as I was unable to do the ‘no-codeine thing.’ I needn’t have worried as he was incredibly understanding.

Remember I was supposed to be withdrawing from codeine as it may be causing rebound headaches. Overuse of common painkillers could be the reason nearly a million people in the UK have headaches, according to the National Institute for Health and Clinical Excellence (NICE). The NICE panel says “medication overuse headaches” can come from taking aspirin, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen) on more than 15 days a month, or opioids, ergots, triptans (a group of specific anti-migraine medicines), or combination analgesic medications on at least 10 days per month.

There is very limited research on the scale of the problem. A German study (Katsarava, Current Neurology and Neuroscience Reports 2009, 9: 115-119) suggested it may affect up to four percent of the population. The specialists who drew up the NICE guidance settle for up to two percent or 1 in 50 people.

It is perhaps common sense that taking too much of any medication maybe harmful. But neurologists are unclear exactly why overuse of painkillers causes more headaches. Somehow the medication disrupts the balance of the body’s own pain control system.

We can end up in the “vicious cycle” where our headaches get worse, so we take more painkillers, which make our headaches even worse, and so it continues. My codeine withdrawal is supposed to end this cycle. It just appears that I need some help (see
Home vs Bali).

So it looks like I’ll be admitted to hospital for 5-7 days to have ketamine (there was also another choice of drug but I can’t remember the name) intravenously fed through my veins.

Ketamine is a fast-acting, dissociative anesthetic. Unlike traditional anesthetics, it works by essentially “cutting off” the brain from the body (that means NO PAIN!). With no external stimulation being delivered to the brain from the nervous system, perception increases to fill the gap left by the missing senses giving rise to a hallucinogenic state also known as the emergence phenomena.

The effects of ketamine vary with the dosage level and method of administration. At lower dosages the effects are mildly hallucinogenic and slightly stimulating. This type of use is often found at clubs and raves. At higher dosages, especially those administered intramuscularly, the effects tend to be more overwhelming. Although descriptions vary greatly, many users talk about alternate planes of existence, a sense of oneness with everything, expansion in awareness of time and new understandings of the fabric of reality and existence. Communication becomes difficult and movement can be nearly impossible.

The onset of ketamine, given intravenously, can occur so rapidly and be so overpowering that a user can be rendered unconscious before even removing the needle. Does that mean I’m going to be unconscious for 7 days? Think about how much weight I might lose? And I may be able to quit smoking, too, then. (Always the silver lining!)

Since that news, I have been for an abdominal ultrasound because of all the trouble with my tummy pre-Bali. Guess what? I have gall stones. Off to my GP tomorrow to find out what the plan will be: Is that going to be a two-in-one hospital trip or two separate trips to hospital? Good thing that I am covered by my health insurance and I have already paid my co-payment – so I kinda want to have two separate visits to make sure that I get my money’s worth from BUPA (my health insurance carrier). And hey! it won’t be too bad – they feed me and drug me and, hopefully, I get flowers and presents! (See? More being positive!)

Let’s Talk About Poo!

Back in early April, I made a quick reference to poo. Now that I’m on stronger pain killers, it may be time to revisit the discussion…

poo-2Most of us who live with FM also have Irritable Bowel Syndrome (IBS). FM and IBS are co-diagnosed in up to 70% of FM patients. IBS (also known as irritable colon, spastic colon, mucous colitis, or spastic colitis) is a disorder of the bowel, or large intestine. It is characterized by severe abdominal pain and cramping, changes in bowel movements, and a variety of other symptoms.

It has been estimated that as many as two-thirds of all IBS patients have FM, and as many as 70% of FM patients may also have IBS. These statistics differ greatly from the corresponding rates in the general population, where only 10%-15% of individuals are estimated to have IBS. It is unknown if the two conditions are related symptomatically or causally, or if their frequent co-occurrence is merely a coincidence.

Adding pain killers to the mix can be frustrating and painful.

Pain killers are used to combat headache, body ache, muscle pain, etc. Prescription painkillers including Vicodin, Darvocet, Percocet, OxyContin, Fentanyl, Tramadol and Lortab are widely prescribed to treat moderate to severe pain. At times (all the time?) we are forced to take painkillers due to too much pain. The opiate analgesics block pain signals by attaching to opiate receptors located in various parts of the body and brain. Prescription painkillers are effective treatments for chronic or persistent pain and can be taken safely, but these pain killers have side effects associated with them. Along with reducing pain, these pain killers also give rise to some other disorders as well.

bird_pooConstipation is a commonly reported effect associated with the use of prescription painkillers. Whether taking opiates at therapeutic levels or abusing them, many users report sluggish bowel movements, a condition which can be both annoying and painful. The problem can be compounded when we are taking a combination of prescription medications. Opiates can interfere with normal elimination by relaxing the smooth muscle in intestines and preventing them from contracting and expelling waste. With regular use of opiates, stools can become rock hard, blocking the bowels. In severe cases, bowels can rupture, leading to sepsis or death. Symptoms of constipation include: abdominal bloating, swelling and cramping; straining to pass stool; pain, discomfort or blood with a bowel movement; nausea; weight loss; and decreased appetite.

The use of a laxative or other form of stool softener is often suggested. Further, to prevent constipation, users must consume plenty of liquids when taking painkillers. Regular bowel movements could also be kept intact by consuming a diet rich in fibre. Mommy swears by prunes (yuck!) and a greasy, cheese pizza tends to work for me!

And, for the sake of completeness:

Mild and More Serious Side Effects

Even with short-term use, patients can experience one or more side effects. They can include sedation, euphoria, dizziness, fatigue, depression, tremors, sleeplessness, anxiousness, flu-like symptoms, upset stomach, dry mouth, pupil constriction, itching, hallucination, delirium, sweating, muscle and bone pain, confusion, extreme irritability and muscle spasms. Taking too much of an opiate medication, or more frequently than prescribed can be dangerous, even fatal. Combining opiates with alcohol and some other drugs can also lead to severe reactions. More serious side effects can include severe respiratory depression, confusion or stupor, coma, clammy skin, circulatory collapse and cardiac arrest.