Nonaddictive Opioid Alternatives Could Come From Chili Peppers

Capsaicin, the active component in chili peppers, shows promise for relieving the sort of nerve pain that leads sufferers directly to prescription painkillers.

Chronic pain. You can't live with it. And living without it is dangerous.

The United States is in the midst of an opioid addiction epidemic - much of it initiated by chronic pain. On an average day in the U.S., 650,000 opioid prescriptions - such as Vicodin and Oxycontin - are dispensed, 580 people start using heroin, and 78 people die from an opioid overdose.

These 'addicts' are not all shiftless junkies. Many of them are average citizens - lawyers, cops, nurses - who turn to heroin when the painkillers their doctor prescribed become impossible to get. The U.S. has cracked down on doctors for over-prescribing opioids. But when patients - still in pain and now also sporting an addiction to painkillers - can no longer get pills, they sometimes turn to heroin in desperation. The US Department of Health and Human Services has named fighting this epidemic a top priority.

Ending this epidemic requires better treatments for chronic pain. And that's where chili peppers come in.

Capsaicin is the active component in chili peppers that makes them taste spicy. It is also an effective topical pain reliever. Centrexion Therapeutics has developed an injectable version of capsaicin, a drug called CNTX-4975, that shows promise for relieving the sort of nerve pain that leads sufferers directly to prescription painkillers - and all the secondary problems - addiction, overdose risk, and subsequent escalation to heroin - that come with them.

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CNTX-4975 is a synthetic capsaicin designed to be injected directly into the pain site to immediately reduce moderate to severe pain without affecting the nerve's touch sensitivity. The pain relief is also lasting. The drug is in trials as a treatment for the painful foot condition Morton's Neuroma and has shown promise as a treatment for knee osteoarthritis pain. These are both chronic conditions for which there is no effective, non-invasive treatment. Both have historically required surgery, which can - and often does - lead to a prescription for opioids for post-operative pain.

Centrexion announced this week that results of its study of CNTX-4975 on patients with knee osteoarthritis pain were promising. "These Phase 2b data show the largest clinically-relevant reductions in knee osteoarthritis pain reported for any drug treatment, marketed or in development," said Randall M. Stevens, M.D., chief medical officer for Centrexion Therapeutics in a published statement.

"They demonstrate that CNTX-4975 has the potential to provide a non-opioid and non-surgical approach to osteoarthritis pain relief that would allow patients to return to daily activities, such as walking up stairs, that were previously too painful." And last month the Food and Drug Administration granted Fast Track designation to CNTX-4975 as a treatment for Morton's neuroma. Till now, the only treatment for Morton's neuroma was surgery, which resulted in pain followed by numbness. CNTX-4975 promises to treat only the pain caused by nerve damage and leave other sensation and joint placement awareness intact.

This is good news not only for patients experiencing chronic pain but also for people watching a pet suffer from pain. Knee osteoarthritis pain is common in dogs as well as humans. And all mammals react to capsaicin the same way. So Centrexion is simultaneously building a canine version of the treatment.

CNTX-4975 is not an addictive opioid so, perhaps in the near future, neither you - or your dog - will have to give up brain function, risk getting addicted, or worry about overdose so you can hike, frolic or just walk up the stairs without pain.

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