I hear paternal grumbling at what I’m about to say. Dr. Gifford-Jones often warned we are a “nation of wimps” when it comes to pain. He believed we were losing the toughening effect that ordinary aches and setbacks once gave us. Furthermore, anyone who has run a marathon, climbed a mountain, or given birth knows that discomfort can be part of life’s great achievements. We can agree that when pain becomes relentless, disabling, or overwhelming, medicine should do better.
Here’s a familiar story. Mrs. B. arrived in the recovery room after surgeons repaired a fractured hip. The operation was textbook. The pain was not. The medical team’s routine treatment was an opioid. Within an hour Mrs. B. was comfortable. A few days later she was calling for refills. Soon she was taking more than prescribed, feeling anxious when she tried to stop, and sleeping poorly.
Older people may remember a time when pain was treated with what now seem like modest tools: aspirin, codeine, local anesthetic, ice, rest, even hypnosis. None were perfect, but none carried the dangerous seduction of modern opioids. When drugs such as oxycodone and hydrocodone arrived, they were welcomed as miracles. They work by attaching to opioid receptors in the brain and spinal cord, muting pain but also activating the brain’s reward system, the same pathway that leads to craving and dependence.
What followed became one of the great public-health disasters of our time. Prescription opioid use exploded in the 1990s and 2000s, fueled by aggressive marketing and the false belief that these drugs were safe when prescribed by doctors. They were not. By 2017, about 2.1 million Americans were living with opioid use disorder, and nearly 48,000 died from overdoses in a single year. The economic cost exceeded a trillion dollars in health care, lost productivity, and broken families. Numbers like that cannot capture the grief of parents who lose a child, or the despair of people trapped by addiction that began with a prescription.
Last year, the U.S. Food and Drug Administration approved a new drug (suzetrigine), the first truly new kind of painkiller in decades. It is not an opioid. It does not act on the brain. Instead, it blocks pain at its source by targeting a protein on pain-sensing nerves called the NaV1.8 sodium channel.
To explain, pain travels along nerves like electricity through a wire. Sodium channels are the switches that allow that signal to fire. The NaV1.8 channel is found almost exclusively in peripheral pain-sensing neurons, not in the parts of the brain that produce euphoria, addiction, or breathing suppression. By blocking this channel, drugs like suzetrigine prevent pain messages from ever reaching the brain, without the high or sedation.
Clinical trials show that suzetrigine reduces post-surgical pain compared with placebo. It does not erase pain the way high-dose opioids do, but it takes the edge off in a way that allows healing to begin. Side effects have mostly been mild itching or muscle spasms, not the nausea, constipation, confusion, and addiction risk so familiar with narcotics. Other sodium-channel blockers are now in development, including those that could quiet pain for weeks after a single injection.
These new drugs may be costly. Insurance coverage may lag. They may not work for all needs, and we may yet discover side effects. There is also the risk that a shiny new “non-opioid” label could distract us from the value of physical therapy, exercise, and other non-drug approaches.
Still, this is science worth watching, and hopefully of better help to people in need.
Editor’s Note: This column offers opinions on health and wellness, not personal medical advice
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