Take One Snail And Call Me In The Morning...continued
Improving On Morphine
For many the solution is not so easy. My roommate for one of my hospital stays had just had a facial nerve cut, in an attempt to finally silence it. But still he was groaning almost constantly.
The obvious treatment is morphine, the king of the opiates. Unfortunately morphine depresses breathing, causes constipation, and makes the brain sluggish. It is notoriously ineffective against the kind of pain that I had, called neuropathic pain, which is the result of nerve rather than tissue injury. And with chronic use the body develops tolerance, requiring ever greater doses to get the same effect.
"People get a certain response and that’s it. After that you’re just chasing that same amount of pain relief," says Michael Rowbotham, director of the Pain Clinic Research Center at the University of California, San Francisco (UCSF), and associate director of the UCSF/Mount Zion Pain Management Clinic.
"There’s no type of pain for which we don’t need new agents," he says. "When you put it all together the question is where to start."
Replacements for morphine are finally being developed. Neither of the leading candidates discussed in this article are available commercially: Ziconotide may be available by the end of 1999, but ABT-594 is still in early-stage trials. Even if ABT-594 passes these trials, it will not be available for several years. But both candidates, developed from chemicals made by sea snails and tree frogs, respectively, hold the promise of stronger and broader action than morphine, with no tolerance.
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