Chronic pain deeply affects every area of a person’s life. More than 100 million Americans suffer from chronic pain, classified as pain that continues for 12 weeks or more. In many cases, the pain persists beyond normal healing time and after actual tissue damage has resolved. Chronic pain is debilitating, impairs how the nervous system functions, and negatively influences one’s quality of life. Research has shown that several biochemical mediators, including prostaglandins, cytokines (TNFα, IL-1ß, IL-6), chemokines (CCL2, CXCL1, CXCL5), growth factors (NGF, BDNF), and neuropeptides (substance P, CGRP) play a key role in the pain pathway and in making pain chronic.
Historically, physicians prescribed long-acting or extended-release opioid drugs to help patients manage their chronic pain. The opioids work to dull the pain by binding opiate receptors in the brain and central nervous system and block the transmission of pain along the neural pathways.
A recent NIH funded study published in Neuron last year used a novel fluorescent nanosensor showing that the way naturally occurring (endogenous) opiates affect the brain is different than exogenous opiates. This has implications for future drug development as well as understanding how these differences may contribute to negative side effects of the drugs taken for pain control.
Opiate drugs are known to be highly addictive. Addiction rates is the U.S. have increased over 200% since 2000 and nearly 2 million people have a prescription opiate addiction with almost 20 million adults (aged 12 and older) in 2017 having a substance use disorder according to the National Survey on Drug Use and Health (NSDUH).
Opiates are known to significantly increase dopamine activity in the reward centers of the brain and shouldn’t be prescribed for long periods, as there is little evidence that they are effective for treating long term, chronic pain cases and in fact can lead to hyperalgesia or increased pain sensitivity. The brain develops a tolerance to opioid drugs This “tolerance” is a term used to describe when a drug stops providing relief at the initial dose requiring increasing doses to achieve the same effect. This may lead patients to take more pain medication than initially prescribed or switch to a more powerful drug to dull the pain.
Drug dependence is an unfortunately common side effect of using opioids to manage chronic pain. The withdrawal symptoms are both physical and emotional, making these drugs extremely difficult to discontinue use. According to the CDC, one of every four people who receive long-term opioid therapy in a primary care setting struggle with symptoms of dependence/addiction to the drugs.
There are, however, a variety of alternative methods of managing chronic pain. One option is a medication that is not opioid-based. These drugs include Anticonvulsants, which helps manage nerve pain, and Serotonin and Norepinephrine reuptake inhibitors, which treat chronic musculoskeletal pain and fibromyalgia pain, as well as depression. Chronic pain often brings depression, mood swings, and interrupted sleep. Tricyclic antidepressants can help fight these aspects of chronic pain. They also have the potential to relieve neuropathic pain.
Complementary and alternative medicine is an additional option. These methods of managing pain don’t require drugs and are generally non-invasive. Some possibilities are kinesthetic, such as acupuncture, chiropractic procedures, and massage therapy. Practicing mindfulness and meditation are strategies to help relieve stress and reduce pain. According to Psychology Today, mindfulness can reduce chronic pain by 90%.
Physical therapy is also beneficial to those suffering from chronic pain. Physical therapy helps re-train the nervous system. Methods include manual therapy, posture awareness, body mechanics instruction and strengthening and flexibility exercises and can help find solutions to improve overall quality of life.
Counseling can be tremendously beneficial for treating the emotional component of chronic pain. Through counseling, individuals can learn healthy methods of coping with pain, stress management, and how to control anxiety.
Opiates aren’t the only answer to chronic pain. Opioid drugs are highly addictive, which can endanger individuals and decrease their overall quality of life. Alternative methods of managing pain, such as non-opioid medications and holistic methods, can help individuals strike a balance between managing their pain and enjoying their life.
Physicians and patients alike should have a specific plan for the dose and duration of an opiate if and when indicated. The goal is to avoid the serious pitfalls of opiate addiction which has become a national epidemic and a serious health crisis to which no one is immune.