The Neuroscience of Pain | The New Yorker

On a foggy February morning in Oxford, England, I arrived at the John Radcliffe Hospital, a shiplike nineteen-seventies complex moored on a hill east of the city center, for the express purpose of being hurt. I had an appointment with a scientist named Irene Tracey, a brisk woman in her early fifties who directs Oxford University's Nuffield Department of Clinical Neurosciences and has become known as the Queen of Pain. "We might have a problem with you being a ginger," she warned when we met. Redheads typically perceive pain differently from those with other hair colors; many also flinch at the use of the G-word. "I'm sorry, a lovely auburn," she quickly said, while a doctoral student used a ruler and a purple Sharpie to draw the outline of a one-inch square on my right shin.

Wearing thick rubber gloves, the student squeezed a dollop of pale-orange cream into the center of the square and delicately spread it to the edges, as if frosting a cake. The cream contained capsaicin, the chemical responsible for the burn of chili peppers. "We love capsaicin," Tracey said. "It does two really nice things: it ramps up gradually to become quite intense, and it activates receptors in your skin that we know a lot about." Thus anointed, I signed my disclaimer forms and was strapped into the scanning bed of a magnetic-resonance-imaging (MRI) machine.

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https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain

HEAL Initiative | National Institutes of Health (NIH)

In April 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD). Successes from this research include the development of the nasal form of naloxone, the most commonly used nasal spray for reversing opioid overdose, the development of buprenorphine for the treatment of OUD, and evidence for the use of nondrug and mind/body techniques such as yoga, tai chi, acupuncture, and mindfulness meditation to help patients control and manage pain.

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https://www.nih.gov/research-training/medical-research-initiatives/heal-initiative

How health insurers are making America’s opioid epidemic worse - Vox

Mandy has now been in recovery from her opioid addiction for more than two months — and she's ready to keep that going. But the 29-year-old in the Chicago area is now dealing with a big obstacle: her health insurer.

Mandy, who asked I use only her first name, said she struggled with addiction for six years. It started with back pain, which a doctor tried to treat with Vicodin. 

"I had tried [opioids] in high school," she said. "I had an older boyfriend, and I tried some of his wisdom teeth painkillers to get high off of. And I was like, 'Whoa, this is awesome.' When I got a Vicodin prescription for my back, I was like, 'Oh, I remember these being really great.'"

Mandy took the drugs as prescribed at first. But every once in a while, she would sneak in an extra pill or two to help deal with a bad day. Then she started taking extras on good days, and, finally, at work.

"It got to the point where I started using them recreationally," Mandy said. "But then I started using them to not get sick" — a typical experience for people addicted to opioids, who over time begin to use the drugs not to get high but to avert cravings and withdrawal.

In March, Mandy decided she had enough. She got into an intensive outpatient addiction treatment program for eight weeks and was prescribed buprenorphine, a medication for opioid addiction that staves off withdrawal and cravings without producing the kind of high that, say, heroin or painkillers might. She's remained on the medication as she's transitioned to less intensive treatment.

There's just one problem: Her insurer, Blue Cross and Blue Shield of Illinois, won't pay for the buprenorphine. That's left Mandy to foot the bill. Her latest bill — for a 28-day supply — was priced at $294 out of pocket, although she got it down to $222.69 with a discount. With the discount, similar bills throughout a full year would add up to nearly $2,900.

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https://www.vox.com/science-and-health/2018/6/4/17388756/opioid-epidemic-health-insurance-buprenorphine