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Mount Sinai School of Medicine
An Integrative Approach to the Control of Intractable Pain from Cancer such as Multiple Myeloma
The relief of suffering is a high priority for patients with cancer and their families. Advanced cancers frequently cause severe chronic pain because of cancer spread to the bones and internal organs. Progress in pain treatment has been achieved over the past decades through increased public awareness, better education of doctors and nurses, and more generous use of strong pain medication of the opioid type, like morphine or oxycontin. However, recent research studies have shown, that many patients suffer from the side effects of these pain medications so severely, that they are reluctant to take the high doses needed to control their agony. Our proposal is to develop a new pain treatment for patients with advanced cancer based on gene therapy that does not cause side-effects, controls symptoms for many months, and can either be used alone or combined with existing treatments to multiply their efficacy tenfold or more (without increasing side effects). To this end, we are using an opioid gene that is targeted to the pain-control center in the spinal cord. Pain impulses caused by cancer anywhere in the body have to travel through the spinal cord before they reach the brain. We have developed a new artificial gene for pain control that can act on the spinal cord, closes the "pain gate" there, and blocks the entry of pain impulses into the central nervous system. The gene is targeted to the spinal cord by a gene vector that would be administered to patients by a spinal tap, a common procedure that can be performed by most doctors in the outpatient office. Furthermore, we will investigate the reaction of the spinal cord to advanced multiple myeloma, a particularly painful type of blood-born cancer that typically affects the bones.