Chronic Pain Management

The Problem of Chronic Pain

Chronic pain is one of the most prevalent and complex medical conditions globally. Some 20% of the population experience chronic pain, diminished quality of life, resulting in large socio-economic impacts that include absenteeism, reduced productivity, and sufferers’ high probability of leaving the workforce altogether.

Practitioners and health care providers, understandably, express great concern that 60% of their patients who are treated for chronic pain respond poorly to their prescriptive regimes. The toll on patients and the costs to society due to the problem of ineffective chronic pain drug treatment are enormous. Furthermore, many patients return to their clinics also experiencing the unwelcome side effects of the current treatment plans based on opioids, antidepressants, antiepileptics, benzodiazepines, and nonsteroidal anti- inflammatory drugs.

QSPainRelief Prescribing Support Tool for Clinicians

QSPainRelief provides effective combinational treatment of chronic pain in individual patients by employing an innovative quantitative systems pharmacology (QSP) pain relief approach.

QSP is an interdisciplinary and holistic science, studying mechanisms of drug effects on the complex interactions between and within biological systems (the body) at the molecular, cellular, tissue, organ, organism, and population levels, using advanced mathematical modeling approaches. QSP is a powerful convergence of biological pathways and pharmacology, using mathematical models that facilitate discovery of new therapeutics and enable individualized medicine with existing drugs.

The Prescribing Support Tool, which is currently under development, assembles existing and new computational models that:

• Simulate the biological processes and neuronal circuits underlying pain relief.
• Represent the central nervous system (CNS) networks which produce drug-induced adverse effects and adverse effects induced by drug combinations.
• Include the central processing of the four major types of pain: nociceptive, inflammatory, neuropathic, and functional pain.
• Model the central processes underlying pain modulation and why individual responses to the same painful stimulus sometime differ.

The Prescribing Support Tool is an integrated service for clinician use in predicting the optimal combination of existing pain drugs for individual patients.

• Input to the Tool includes patient characteristics (age, sex/gender, disease status, and genotypes) and clinician-patient goals for heightened analgesia and decreased side effects (sedation, cognitive impairment, and drug abuse liability).
• Output is presented as an optimal set of drug combination treatments for stratified patient groups with chronic pain with respect to utility (the balance between analgesia and side effects). Clinician interaction with the Tool enables the prescribing clinician to exercise experience and judgment, adjusting dosages and drugs to fine tune combination treatments along a spectrum that trades off desired analgesic effects versus undesirable side effects for better patient results and heightened satisfaction, based on the individual characteristics and preferences of the patient.
• The Tool also predicts drugs and/or drug combinations to be avoided for a particular patient set of characteristics and preferences.
• The Tool has modeled the efficacy and side effects of over 100 analgesics and augmentation drugs currently in use covering all combinations of those drugs the clinician is likely to consider.