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Anesthesiology, Neuroscience, Pain, Stanford News

When touch turns into torture: Researchers identify new drug target for chronic, touch-evoked pain

When touch turns into torture: Researchers identify new drug target for chronic, touch-evoked pain

I admit it: I’m a baby when it comes to the smallest bruises. But I do feel guilty about fussing over papercuts when I hear about people with tactile allodynia, a chronic pain condition where the slightest touch can cause searing pain.

Allodynia, meaning “other pain,” refers to pain from things that shouldn’t normally hurt. For people with tactile allodynia, or touch-evoked pain, simple needs like a hug or a soothing breeze can turn into nightmares. Everyday activities such as brushing their hair or putting on a shirt can hurt. They can certainly kiss their NFL dreams goodbye.

Treating such chronic pain is tricky, because the root cause is not a wound that can be patched up with a Band-Aid. The culprit is often a damaged nerve or nerve circuit, leading to a mix-up of pain and touch signals, and fooling the brain into misreading touch as being painful.

Painkillers such as morphine haven’t been very effective at quelling this particular type of pain so far. That’s because they may have been targeting the wrong nerve cells all along, researchers here reveal.

Their recent article in the journal Neuron describing the finding points out that the nerve cells, or neurons, that control this type of pain are different from the usual pain neurons that morphine-based drugs target.

In my Inside Stanford Medicine story, I describe how the finding can help drug companies develop the right drugs to treat this type of chronic pain. Senior author of the Neuron article, assistant professor of anesthesiology and of molecular and cellular physiology Gregory Scherrer, PhD, and colleagues, zero in on specific binding sites on these neurons that drugs can target in order to cut off their signal and numb the pain.

Because the underlying nerves spread through the skin, topical creams or skin patches carrying the right drug would work quite well to reduce the pain, the authors say.

In the story, Scherrer also explains why drug companies gave up on such drugs before, and how his research could now help these companies successfully develop drugs to help patients with this type of pain.

Previously: Do athletes feel pain differently than the rest of us?Toxins in newts lead to new way of locating pain and On being a parent with chronic pain 

Emergency Medicine, Health Disparities, Research, Stanford News

Insurance status might perversely affect the kind of trauma care you get: Stanford study

Insurance status might perversely affect the kind of trauma care you get: Stanford study

trauma centerGiven how much my health insurance checks eat into my income, I shouldn’t need to worry about the kind of trauma care I’d get if I were ever in a car accident (knock on wood). But should I?

A new School of Medicine study reveals that even insured patients might be at risk for getting poor trauma care for severe injuries – possibly at greater risk than uninsured patients.

Why? Simply because emergency doctors at hospitals lacking a trauma center decide to keep them there instead of sending them to a hospital with more expertise.

Ironically, insured trauma patients are admitted at non-trauma hospitals at higher rates than uninsured patients are, researchers find. Ergo, insured patients may end up missing out on critical resources that trauma centers are equipped with for severe injuries.

Our press release on the study published online today reports on the researchers’ findings from analyzing more than 4,500 nationwide reported trauma cases.

Why would non-trauma hospitals want to hold on to insured patients? One possible reason is that sometimes emergency doctors fail to recognize conditions that need extra care, lead author M. Kit Delgado, MD, suggests. Hospitals may also be used to taking care of certain severe injuries on their own.

But there might also be other reasons. As Delgado elaborates in the release:

Doctors working in the trenches most often strive to do what’s best for patients. But these findings are concerning and suggest that non-trauma centers are considering admitting some patients with life-threatening injuries based on whether or not they can be paid, when research has shown these patients fare better if transferred to a trauma center.

Delgado carried out the research when he was an emergency medicine instructor at Stanford. He is currently an emergency care research scholar at University of Pennsylvania.

Calling the finding “very disturbing,” Nancy Wang, MD, senior author – and an emergency physician herself – says researchers must call attention to such disparities in trauma care. She and colleagues previously discovered disparities in access to trauma care at California hospitals between children with and without insurance.

“I believe in health care as a right,” Wang wrote to me. “I never believed that there would be disparities in access to emergency trauma care based on insurance status.”

The authors suggest closer monitoring of emergency room encounters and splitting costs between hospitals and trauma centers as potential ways to curb such practices.

In follow-up studies, they also hope to figure out how much patients know about their options, and whether their preferences are being taken into account. As Delgado says in the press release, “People who have insurance may not realize that they could do better if they are transferred.”

Previously: Comparing the cost-effectiveness of helicopter transport and ambulances for trauma victims
Photo by Seattle Municipal Archives

Cancer, Dermatology, Research, Stanford News

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

anti-fungal pill

Curing cancer isn’t cheap; developing new drugs comes with a multimillion-dollar price tag. Plus, there’s the rigmarole of animal testing, IRB reviews, FDA approval, and so on. What if you could just skip all of that, and get the drug to patients directly and at a lower price than an existing treatment option? You could, if you can successfully recycle a drug that’s already on the shelves at the pharmacy.

A few years ago, Stanford researchers led by Philip Beachy, PhD, got an inkling that a pink-and-blue capsule that removes unsightly toenail fungi also has a secret superpower: It might be able to treat skin cancer. The first set of clinical trials testing the effect of the oral pill, itraconazole, on skin cancer is the focus of a new study published online today.

Led by Stanford dermatologist and senior author Jean Tang, MD, PhD, the study shows proof of itraconazole’s ability to reduce tumor size and spread in patients with basal cell carcinoma, the most common type of skin cancer.

“We are shortcutting the [drug development] process,” says Tang, “by using a drug that’s already been around for 25 years and given to tens of thousands of people.”

From our press release on the study:

Itraconazole, which is prescribed for common fungal infections, kills fungal cells by blocking the production of a vital membrane component. In cancer cells, the drug appears to disable the Hedgehog signaling pathway — a cascade of cellular events triggered by the Hedgehog protein signal that is vital to cell growth and development.

Oral drugs for basal cell carcinoma are rare. These tumors are usually treated through radiation or cut out surgically. But surgery on advanced stage tumors may not always be effective and can greatly scar and disfigure patients.

Tang tested the drug itraconazole on 29 patients with a total of 101 tumors and found that it both blocked the Hedgehog pathway and reduced tumor size at the normally-prescribed anti-fungal dosage. As I describe in the release:

Patients were given itraconazole pills twice a day for a month. Another small group was given a lower dosage of itraconazole for a longer duration (an average of 10 weeks). In the first group, the drug reduced Hedgehog pathway activity by an average of 65 percent and tumor size by 24 percent. Patients in the second group, with lower itraconazole doses, showed similar reductions in tumor size.

And the best part? This medication is several times cheaper than vismodegib, the current and only go-to oral drug for basal cell carcinoma ($20 versus vismodegib’s $250 per day). It can also potentially treat tumors that are immune to vismodegib and other Hedgehog-pathway-blocking cancer drugs, says Beachy.

Ranjini Raghunath is a writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: New skin cancer target identified by Stanford researchers, Funding basic science leads to clinical discoveries, eventually, Studies show new drug may treat and prevent basal cell carcinoma and Common drug might help prevent skin cancers
Photo by Worak

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