The whole picture of pain – pain management now and in the future

Orion is particularly focusing on the management of pain, a common problem with extensive individual and social effects. Suffered by a surprisingly large proportion of the population, chronic pain can affect our ability to work. New technologies are expected to revolutionise pain management.

Pain is commonly divided into acute or short-term pain and chronic or long-lasting pain. Orion is focusing particularly on the latter. 

Our vision is to give chronic pain patients their lives back,” says Pain Research Director Carina Stenfors, who is heading the Sensory Hyperexcitability unit. 

Chronic pain is a global problem: one in five suffers from chronic pain at some point in their lives, says Stenfors.  For pain to be chronic, it has lasted 36 months or longer. 

“The most common chronic pain is low back pain, frequent in the working-age population. Pain comes with a price tag: in addition to human suffering, chronic pain can have economic and social consequences through sick leave and incapacity for work.” 

One of Orion’s R&D core therapy areas is neurological disorders, which includes also pain research. According to Carina, several drug candidates are currently in the preclinical phase, which means that they have not been tested in man yet. One product is already tested in man - it is not a drug, but a pain therapy based on virtual technology, unique in its kind. 

All treatments can have adverse effects 

Pain is today usually treated with anti-inflammatory drugs such as ibuprofen or antidepressants, antiepileptics or opioids, the opioid mainly for acute pain. According to Stenfors, treatment is effective if pain symptoms decrease by at least 50 percent. 

 “But for the majority of people the relief is lower than that and comes with adverse effects.” 

Younger patients may have to use pain relief for a long time. 

“Pain medications are difficult and complex to develop. Testing can also be challenging, as drugs must be absolutely safe and effective. We have currently a number of projects under way from the first idea to the preclinical phase. If we succeed, one of the drugs may enter the clinical phase in the near future.” 

New technologies offer many opportunities 

The core therapy areas of Orion's R&D are neurological disorders, oncology, Finnish heritage rare diseases and respiratory diseases. Pain research is included in the neurological disorders research. It started seven years ago, first with the focus on neuropathic pain and then in recent years expanding to chronic pain. 

“It’s wonderful to be able to exploit also new technologies such as virtual technology, as we do in the ongoing pain therapy research. The project started a year and a half ago and we have already been able to test virtual technology with some patients suffering from lower back pain.” 

 Pain often makes patients fear or avoid many things, such as large crowds or daily chores. A patient’s life may shrink to inside the walls of the home. Virtual technology enables the user to experience new environments and gives the opportunity to provide variety of content. 

The use of virtual technology for pain management is been studied at Orion’s own research unit. In spring 2020, the clinical trial had to be postponed, however, due to the coronavirus, but in the autumn, the study has continued as a safe remote trial.  Participants do not need to visit the research unit, and recruitment and other contacts take place via video calls. 

In addition to Stenfors, the masterminds behind the idea include Development Pain Director Raymond Bratty from Nottingham and Digital Medicine Director Sammeli Liikkanen from Turku.  A few years ago, the trio began to consider the possibility of virtual therapies after discovering that a virtual reality software had been developed in the United States for acute pain in burn patients. 

“We started to think whether such a programme could also be developed for the treatment of chronic pain. A virtual method could help people manage their pain better and retain their functional capacity.” 

Searching for international partnerships 

Orion’s pain team together with many other R&D professionals, depending on the phase of the project work hard to find new possible treatments. The virtual technology project team also includes a British psychology Professor and a small Finnish IT company. 

“The core team is at Orion, but we collaborate globally. A small pharmaceutical company like us has to be resourceful and agile when looking for international partnerships,” Stenfors says. 

“And we’ve done well!” 

Pain and depression – crucial relationship between cause and effect 

Pain management has stimulated a lot of interest in Finland as well: some time ago the University of Helsinki arranged a public seminar with lectures by pain experts, professors Eija Kalso and Nuutti Vartiainen. According to Eija Kalso, Director of the Pain Clinic at HUCH, poor sleep and anxiety can easily lead to a vicious circle where it is difficult to know the difference between cause and effect. 

Stenfors says that chronic pain can also increase suicide risk.  

“Which comes first: a depressed person suffers from poor sleep and experiences pain, or a person in pain cannot sleep and gets depressed? It’s a vicious cycle that needs treatment.” 

Brain imaging can also be used to examine chronic pain patients and to understand cause and effect. According to Neurosurgery Resident Nuutti Vartiainen, measuring spontaneous brain activity may in future help diagnose chronic pain and develop treatment methods. 

Rating patients by pain, not disease 

In principle, the development from acute to chronic is very similar in depression and pain. Stenfors says that pain is often a symptom caused by different diseases, such as cancer, diabetes or AIDS One tries to treat the underlying disease first and hope that this would ease the pain as well. 

“But instead we could use the pain itself as an indicator and try to find the factors and mechanisms causing it. This could lead to development of various pain treatments.” 

Besides the virtual method Orion has also collaborated with a number of gene banks in Finland and abroad. The symptoms of pain are often directly associated with genes. 

“We are expecting more research data about pain mechanisms in the near future to be able to group patients by their symptoms. These are fascinating times: when it comes to pain, we should make use of novel research and be open to new ideas for treating pain patients.” 

 

Text: Tarja Västilä

2 November, 2020

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