Certified Registered Nurse Anesthetists (CRNAs) are experts in pain management — and one CRNA is conducting research that could pave the way for new non-opioid treatments for neuropathic pain.
A member of the American Association of Nurse Anesthesiology since 2012, Rhea Temmermand, PhD(c), MSN, CRNA, is the only CRNA pursuing a
PhD in Pharmacology & Physiology at Drexel University College of Medicine. Her research is focused on treating chronic neuropathic pain with compounds that were developed from spider venoms.
“Non-opioid drug development for chronic pain is a big and up-and-coming field, and neuropathic pain is a disease process that is still not completely understood,” Temmermand said. “Neuropathic pain is perhaps the hardest pain condition to treat, so there are just not a lot of options out there for people who experience it.”
She said some people experiencing chronic pain can take other types of medications like antidepressants and anticonvulsants like gabapentin. However, they don’t work well and have numerous side effects.
“There’s a big need for developing new medications, and that excites me as I’ve always had an innovation-type mindset. I wanted to be a part of something that was brand new. My dream would be to hear from somebody who takes a medication I helped develop and have them say that it works and they live a better life because of it,” she said.
Her current project is “The Development of Glutamate Transporter Modulators as a Novel, Non-opioid Treatment for Neuropathic Pain.” She studies compounds developed from spider venoms that help decrease pain signaling in the brain with minimal adverse effects. Temmermand is doing animal and molecular work with the goal of bringing the compounds to clinical trials, she said.
Last September, Temmermand won an award in an international conference for pain research from the International Association for the Study of Pain (IASP). She attended the association’s conference in Lisbon, Portugal, where there were 600 attendees and 300 presentations.
Temmermand was the only CRNA in a group that included neuroscientists, neurosurgeons, and other types of physicians. Winning the top presentation award at the ISAP conference “was a total shocker,” she said.
After she got over her initial shock, Temmermand said she believes she won the award due to the unique nature of her research. “Most pain research programs specifically focus on cells called the neurons — the brain cells. The neurons transmit the pain information, so a lot of molecular work is done on them. Our lab is unique in that we look at other types of cells, called glial cells, and specifically, cells called astrocytes. Often, researchers never think to look at those types of cells because they’re not the ones that transmit pain information.”
She continued, “However, those cells surround the neurons, and provide a healthy environment. Or if there’s damage that occurs, like ischemia or excitotoxicity, they help with mitigating this damage. Essentially, they keep the neurons healthy. When those support cells aren’t functioning optimally or when they’re damaged, then neuronal health can decline. In our lab, the drugs that we develop help support those support cells.”
In addition to her research being focused on a topic that’s not typically looked at in the pain field, Temmermand said people are interested in her lab because the compounds they study are inspired by natural resources — in this case, spider venom. Having identified the molecular structure, they now synthesize the compound in the lab, however the compound was originally developed from the Parawixia bistriata spider from Brazil.
“Venoms in general — not just spider venoms, but all types of creatures’ venoms — were traditionally used in drug discovery, but not as much anymore because we have high-throughput ways to create drugs now with computer modeling. But the original way to create drugs is to use compounds that are inspired from nature,” she said.
Venoms are specifically looked at because for a venom to work, it must modulate a certain part of the nervous system, like an ion channel, she explained. “But the physiology of an insect is a lot different than the physiology of a human. We could take advantage of that difference and of these properties and use it to treat certain diseases.”
As an example, she said if a compound in an insect modulates the nervous system and causes paralysis, the same exact compound in a human would be neuroprotective — protecting the neurons from injury – because the compound’s target may have a different purpose in various organisms.
Drug development can take a long time, often upwards of 10 to 20 years, and be very costly. Temmermand said she’s excited to help society and the nurse anesthesiology profession through the creation of new analgesics as well as other ventures.
She is passionate about the foundational scientific education of nurse anesthesiology residents, she said. This year, she’s promoting that goal by co-editing a science textbook (with Edwin Aroke, PhD, CRNA, FAAN, FAANA, an associate professor at the University of Alabama at Birmingham) for residents that will include chemistry, molecular biology, and physics related to anesthesia practice. There is no current resource available on these topics. More than 60 CRNAs from around the country are working on the project, and publication is expected in 2025.
Temmermand is also launching a new educational platform in summer 2024 that she said will provide residents and faculty with additional resources to train CRNAs in foundational science, anatomy and physiology, pathophysiology and pharmacology with application to clinical practice.
In addition to the textbook and educational platform, she continues to look at ways CRNAs can contribute to being a solution to problems such as the opioid epidemic, and how CRNAs can properly manage pain and provide adequate pain therapy in the community. She believes people would be less likely to develop substance use disorder with proper non-opioid interventions delivered by CRNAs as part of their pain management plan.
“CRNAs are extremely skilled and talented providers and our role as CRNAs can extend beyond the operating room and the hospital,” she said. “We have a big community impact, and I want to inspire and assist other CRNAs to reach their full potential.”