Episode 16: Journavx - Nerve Block in a Pill! A Game-Changer for Pain Management or Just Hype?

In this episode, Dr. Karmy will review everything known so far about the newest and first-in-class non-addictive pain medication, Journavx. 

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Chapters

• 0:39 Introduction
• 1:32 Mechanism of Action
• 4:04 Advantages
• 5:03 Disadvantages
• 6:37 Possible Side Effects
• 7:22 Possible Indications

Transcript

Raveena: 0:00

Welcome to another episode of Chronic Pain Chronicles with Dr. Karmy, where we discuss a new pain medication that's been making waves in the U. S., Journavx. Released by Vertex Pharmaceuticals, this drug represents the first new class of pain medication in over 30 years. I'm Raveena, your host and advocate for understanding what this means for chronic pain patients. We're joined by Dr. Karmy, an expert in pain management, with over 20 years of medical experience to break down the science behind Journavx and its potential impact

Dr Karmy: 0:39

Hi, this is Dr. Karmy, and today I wanted to touch briefly on a new medication which is generating a lot of hype in the USA called Journavx. It was manufactured by Vertex Pharmaceutical, a very cutting edge biotech company from the States and the excitement is mostly because it is a fundamentally new class of pain medications. In fact, this is the first new class of pain medications in over 30 years to hit the market. It just got approved by FDA for acute pain based on studies in post operative pain. So, how does Journavx work? It works by blocking sodium channels. Sodium channels is how nerves communicate with each other and with the brain. The problem with blocking sodium channels is that they are used widely for a number of different functions in your body. For example, if you blocked every sodium channel in your body, you would become paralyzed because it is also, required for nerves which move muscles. So, what Vertex Pharmaceutical did, and what's unique about this medication, is that Journavx only blocks a very specific subtype of sodium channel called NAV 1. 8, or voltage gated sodium channel 1. 8. What's unique about Sodium channel 1. 8 is that it primarily is present on nerve endings which transmit pain signals and is not present on other nerves in the body which do other things such as move muscles. Interestingly, the mechanism of action is very similar to mechanism of action of nerve blocks. Nerve blocks block all sodium channels. They're not selective. So the selectivity comes from Injecting one pain generator and medicine primarily staying in that one pain generator whereas with Journavx selectivity comes from the fact that it doesn't affect all sodium channels and Another use or another treatment that blocks sodium channels is lidocaine infusions, unlike nerve blocks, which only target specific pain generators, with lidocaine infusion, the medicine spreads throughout the whole body, but at doses which do not paralyze muscles. Based on what I've explained so far, you can already see the advantages of this new medication over some of the older medications that have been used for pain. First of all, it is not addictive, like opioid medications. Also, it does not cause kidney or stomach damage the way that Advil or other non steroidal anti inflammatories can. This medication does not seem to make one drowsy, as it primarily affects nerve endings and not the brain. I would imagine a lot of patients currently on opioids would want to try these medications. In terms of side effects, the ones we know so far are relatively minor. Journavx can sometimes cause itchiness and on occasion can cause a rash. Keep in mind that this is a new medication and often side effects come out when the medication is used by a large number of people over a long period of time. One barrier that I anticipate to the use of this medication is cost. As I mentioned, it was only approved for acute pain, while I suspect a lot of patients will want to use it for chronic pain. At present time, the medication costs 15 US dollars per pill and is normally taken twice a day. The price would not be terrible if somebody took one or two pills a month. However, if a patient tried to use this medication to control their chronic pain, the monthly cost would be well over a thousand Canadian dollars per month. The other questions simply arise because this medication is so new. If used for chronic pain, will the patient develop tolerance like they do with opioids, which work very well during the first few weeks or months of use, but become a lot less effective within a year? Also, is there a risk of joint damage? If the patients are unable to feel when they are exercising too much and injuring their joints. Finally, there is a question of whether or not this medication will replace some of the other treatments for pain that are currently used in Ontario, such as nerve blocks and lidocaine infusions. I think it is too early to tell because it all depends on the effectiveness of this medication for chronic pain. My guess is that it has a reasonable chance of replacing lidocaine infusions. However, it is less likely to replace nerve blocks because with nerve blocks, you're able to concentrate a lot of medication in a specific source of pain, while with Journavx, the medication would grow and distribute equally throughout the whole body. Will Vertex Pharmaceutical go after chronic pain indication? I have no doubt that they will, because chronic pain market is far bigger than acute pain market. And in fact, they already have done some preliminary studies for chronic pain, but the results are not as strong as for acute pain. Will this medication come to Canada? Again, nobody knows, as Canadian market is much smaller than U. S. market, but based on past experience, I would say most of the time the medication will arrive here. It's just a question of time.

Raveena: 9:24

Thank you for listening to this episode of Chronic Pain Chronicles with Dr. Karmy. If you enjoyed today's discussion, be sure to check out our previous episodes where we've explored topics like nerve blocks, PRP therapy, and upcoming innovative approaches to chronic pain relief. Stay informed, stay empowered, and as always, take care of yourself. Until next time on Chronic Pain Chronicles with Dr. Karmy. Disclaimer, when it comes to your health, always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only and should not be considered medical advice or a substitute for professional medical care.