Researchers at the Medical University of South Carolina’s Department of Anesthesia and Perioperative Medicine have discovered that an FDA-approved medication may help reduce pain following surgery. The pilot study, published in the Pain Management journal, found that spinal surgery patients receiving N-acetylcysteine during surgery, along with standard pain control treatment, reported lower pain scores. They also requested fewer opioids following surgery.
Opioids may be prescribed for a brief period to relieve pain after surgery. While they are effective, their potency and addictive potential can diminish over time. This can be dangerous if not under the supervision of a healthcare provider. Physicians welcome the chance to limit opioids in pain management.
Can we completely stop giving opiates? Most likely not. Can we reduce the amount of medication patients require? “We should try.”
Sylvia Wilson, M.D., is the Jerry G. Reves Chair in Anesthesia Research at the Department of Anesthesia and Perioperative Medicine and the principal investigator of this study.
Wilson has been working on improving pain management and limiting opioid use after surgery for many years. It turns out that a collaboration between her and a basic researcher within her Department may offer a solution.
A partnership for success
Wilson began working closely with Michael Scofield, Ph., who is the Jerry G. Reves Chair in Basic Science Anesthesiology Research. Scofield was also a senior co-author of the study. Scofield conducted laboratory research into NAC, a drug used to treat liver damage, acetaminophen toxicity, and mushroom poisoning. Scofield and other researchers have studied the effects of NAC on the nervous systems, particularly in addiction and pain perception. Scofield and Wilson were a perfect match because of their clinical goals.
Scofield said, “This project represents a beautiful synthesis between basic science and clinical studies. We are taking things that we have found to be effective in laboratory settings and bringing them into the clinic.”
Wilson is convinced that collaborations between doctors and basic scientists will lead to clinical advancements. She attributes the environment of support created by former College of Medicine Dean Jerry G. Reves and Chairman Scott Reeves, M.D., within the Department for such partnerships.
Trial insights that are promising
The team of researchers chose spinal surgery patients as the subjects for their pilot study because they often suffered from chronic pain prior to surgery. They are also more likely to experience higher opioid levels before, during, and even after surgery. Patients received standard anesthesia during surgery along with a NAC infusion or a saline solution. Then, information on the patients’ pain levels and their opioid consumption was collected.
CHEMUK Highlights of 2022 eBook Compilation of the most important interviews, articles, and news from the past year. Download the latest versionPatients who received NAC (150mg/kg) via IV infusion received, on average, 19% less opioids than those who received saline. NAC patients reported less pain and also took longer to ask for pain medication following surgery than saline. Researchers were encouraged by the fact that the positive effects lasted longer than NAC would have been expected to stay in the body.
Wilson said, “I think it’s important that we’ve seen this medication’s impact persist.” “We don’t see a rebound when the medication wears off.”
Scofield’s previous laboratory research on the effects of pain had also shown similar results.
Scofield said that NAC’s preclinical studies had shown that the protection against relapse is long-lasting. “Certainly, we hope that this is something that will last a long time,” said Scofield.
Look to the Future
The research team will then investigate whether these findings can be applied to other procedures. The researchers are enrolling patients who will undergo minimally invasive procedures such as hysterectomies in a larger study. Researchers will be able to conduct deeper statistical tests as more patients register, which will improve their understanding of NAC’s effects on surgery-associated discomfort. They can then set up future clinical trials of NAC in surgery.
Wilson said that to change the practice of surgery, it is necessary to conduct large-scale clinical trials in different settings and with different types of surgeries. This will show you whether you are causing harm or benefit. “We need to demonstrate good clinical efficacy but also safety.