'I think it's a game-changer for acute pain management'

Two experts in treating pain at MUSC Health are looking forward to the arrival of a new non-opioid pain medication next month. The Food and Drug Administration has approved the use of suzetrigine (Journavx) for adults with moderate to severe acute pain, the kind a person would feel after surgery or an injury. 

Sylvia Wilson, M.D., specializes in regional anesthesia and acute pain after surgery. “It's a big deal. It's a whole new class of drugs. I'm excited to see where it goes and what happens,” she said of the new medication.

Meron Selassie, M.D., helps people suffering from chronic pain. Journavx has not been approved for them yet – only for people with short-term pain. Studies are underway that could change that one day. In the meantime, Selassie said: “I think it's a game-changer for acute pain management in high-risk populations, post-surgical pain management – if it can be affordable for people.”

That affordability issue is important to consider. But first, a look at the medication itself.

What is it?

Journavx is a pill that tackles pain from a new angle, Wilson said. “It's working on peripheral nerves before they can communicate to the spinal cord, reducing pain signaling."

 

When a person is hurt, it creates pain signals at the site of the injury. Normally, those signals travel through the peripheral nervous system to the spinal cord and, finally, the brain, which causes the person to feel pain. Selassie said Journavx interrupts that process.

Research also found that Journavx works as well as the ingredients in Vicodin – hydrocodone and acetaminophen –  but has the advantage of not being an opioid. That distinction stands out to Wilson. “It can't be abused. It doesn't have the high of opiates either,” she said.

Instead, Journavx is what doctors call a sodium channel blocker, a category that includes the drugs Lidocaine and Novocain. Selassie said older medications in this family are “non-selective.” “So they're really effective at blocking pain, but they also block receptors throughout the body. They're limited in how long you can give them.”

Wilson said Journavx blocks pain-sensing neurons. “So you could still feel the ground underneath you. You could still have full function of your limb. You just feel less pain.”

Side effects, plus who shouldn’t take the new pain medication

Some people may feel side effects from Journavx, but Selassie called them mild. “Itching, muscle spasms and rash were the three most common ones. In their studies, patients only took this medicine for two weeks. So we have data to support its use up to 14 days, but at this point, we can't make any conclusions about its safety beyond that.”

 

There are conclusions about who should avoid Journavx. Wilson said people with severe kidney or liver disease should not take it. The company also warns that Journavx may make medications that are “strong inhibitors” of the enzyme CYP3A less effective. That includes some blood pressure or heart medications, antibiotics, antidepressants, antifungals and protease inhibitors.

Wilson said there’s also concern that Journavx interferes with oral contraception. “And there's also no data or knowledge with pregnancy or lactation at this time."  

Importance of treating pain

Also notable: the importance of treating pain, Wilson said. She works with patients who are having surgery. “We do know that untreated acute postoperative pain can translate into long-term chronic pain.”

Selassie sees the impact of chronic pain on her patients and the effect good pain management can have. Without it, she said, pain can take a toll on many areas. 

“It reduces quality of life. It can lead to depression and anxiety if untreated. And as physicians, our primary goal is to improve the quality of life for people. So it's important not to ignore pain, especially acute pain. And medications like this are another tool in our toolbox to stop that transition from acute to chronic.”

The cost

How much will that new tool cost? About $30 a day for two pills. That’s more expensive than older medicines that people take after surgery. 

It’s unclear how insurance agencies will handle it. Anticipating that, Journavx is offering a savings card for people with commercial or government-sponsored insurance whose policies don’t cover the medication. 

But Selassie remains concerned. “It could be like the problem we’ve seen with GLP-1 medications. Ozempic and other weight loss medications have been successful in the way that they allow people to lose weight, but they're unaffordable for a lot of people. And so I worry that that might be in store with this medication, but I think we’ll just have to see.”