Do Opioids Reduce Inflammation in Chronic Pain Patients?

July 3, 2013September 27, 2016 / Thomas Cohn, MD

A recent preliminary study found that inflammation in patients with chronic pain is persistent despite long-term opioid treatment.

The study was carried out by Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina. Dr. Tennant examined 40 patients from July 2012-October 2012. All of these patients had been receiving heavy doses of opioids to treat their chronic pain for the past 10 years.

While many patients reported improved levels of depression and function, 20% of those surveyed still had high levels of inflammation markers. Further, a number of patients had abnormally high hormone levels.

Dr. Cohn Comments

Opioids are used to treat all types of pain, but they do not treat inflammation. If a chronic condition causes pain, such as osteoarthritis, treating this with opioids will not change the inflammation that is occurring. The pain may be better with the opioids, but the disease is not being modified and one should expect to see inflammatory markers.

Chronic pain is defined as pain lasting longer than 3-6 months. Pain can be caused by any number of factors, and is a response to ongoing stimulation of pain receptors in the body. It is not very surprising that if we monitor blood borne markers, we can find elevations in those that are indicators of inflammation.

Osteoarthritis is a chronic degenerative joint disease. If it is painful, there is likely active destruction of tissue, and the joint may be warm and swollen. Osteoarthritis of the knees is very common, and we all know many older adults who complain of painful, swollen knees. Furthermore, the most common treatments are nonsteroidal anti-inflammatory drugs, like Motrin and Aleve.

Low back pain has many causes, such as:

Inflammation of nerves causing radiculopathy
Degeneration of the facet joints

First line treatments are meant to reduce inflammation. This is done sometimes by oral steroids, or long-acting steroid epidural injections. Steroids treat inflammation directly, and finding inflammatory markers when someone has low back pain is not surprising.

If a person has chronic pain, a good pain physician will recognize the causes of the condition. Treating the cause of pain with interventions that modify the disease is the best strategy. Treat the disease, and the disease markers will improve. Opioids are often a Band-Aid – they help in the short term but fail to address the underlying condition.

Related Sources:

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Low Back Pain: Signs & Symptoms of a Bad Disc

July 1, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain from a bad disc is very common. By the age of 30, discs often begin to show signs of wear. By age 40 disc pain is normal.

The human body was initially built to last roughly 40 to 50 years. Up until about the mid 1800’s, most people would die by this age due to:

Trauma
Infections
Disease
Heart problems

Since that time, science and medicine has developed tremendously, and we have improved our longevity well into the 70’s and 80’s for many people. The problem as we live longer, is that we are out living the natural life expectancy and durability of many of our body parts. We are wearing out the spine, the disks, bones, joints and sometimes the nerves. As we age, our body parts age, become damaged, and cause us pain.

Signs you have a Bad Disc in your Back

The first sign that you have a bad back disc is often radicular pain – that is pain that starts in the back and radiates into the buttock or leg, either one or both sides. Sometimes it starts after moving wrong, bending and twisting, or lifting something too heavy. People who suffer from this often don’t know exactly what happened. They simply notice annoying, ongoing pain from the back into the leg.

Having low back pain and a bad disk is not unusual. A bad disk does not mean that you need surgery. However, having ongoing back pain means that you need to do more maintenance to keep going. Just like having an older car, an aging body needs more work on a regular basis to keep running. If you ignore everything, it will stop working well. But unlike an old car, you cannot just go to the local mechanic to keep things running. To keep the back well tuned, you need the advice of an expert and you need to invest in your own health.

Spinal Disc Treatment Options

Most back disc problems can be treated conservatively, without surgery. Treatment ranges from simple to aggressive based on what works and what is wrong. Surgical treatment should be reserved mostly for discs causing neurologic damage including weak muscles in the legs and loss of control of the bowel or bladder. This is rare though – less than 2% of all disk problems need surgery.

If the low back pain is radicular and has not responded to simple treatment in 4-6 weeks, it is time to find a Physical Medicine doctor who specializes in pain. These are experts in diagnosis and treatment of these problems. They can start simple, from medications and therapy, and move to the most complex solutions if necessary. Interventionalists are pain doctors who may also do injections to diagnosis specific problems and perform complex procedures that treat the pain without surgery. Often these doctors can determine if the pain may be coming from several different sources, and how to treat each of the specific problems so that life is not a pain.

Acute Pain vs. Chronic Pain: Definitions & Differences

June 3, 2013September 27, 2016 / Thomas Cohn, MD

There are many definitions of pain. Because pain is often subjective, everyone will define and describe it in their own personal terms.

Dictionary vs. Medical Definition of Pain

The dictionary describes pain as physical suffering or discomfort caused by illness or injury. Medicine becomes very technical in its description of pain, often concentrating on the physical aspects, structures involved, and trying to determine if it is “real.” The International Association for the Study of Pain (IASP) defines pain as:

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Pain has both physical and emotional correlates. If someone has pain, there is usually a physical cause in the body that needs to be found. Pain may also have significant emotional correlates in the brain. The processing centers in the brain for many pain signals sit next to the areas that control emotional stability. Therefore, if people have significant amounts of pain, spread of pain signals to emotional areas of the brain can easily occur, affecting mood and depression.

Pain is always subjective. It is a learned experience, and it is very individualized. A person learns what pain is through experiences related to injuries as a child and as they grow up.

Acute vs. Chronic Pain

In medicine, pain is the interpretation of certain sensory signals, generated from a variety of receptors in the body. When the sensory signals are ongoing, most people interpret these as pain, and seek treatment to relieve them. There are two primary types of pain:

Acute pain is from definite tissue injury and will fade after the cause is identified and treated. A common example is cutting a finger – it hurts, it heals, and the pain is gone.
Chronic pain occurs when damage causes ongoing sensory signals for long periods of time, and in some degree becomes independent of the actual tissue damage. This type of pain is difficult to stop, and often the best treatment is working on systems to manage the pain.

Understanding the complexities of pain, the body, the sensory nervous system, and the overall interactions in the body are some of the important aspects for a medical doctor who treats patients with pain. A good pain physician understands people and medicine and how all these interact, allowing them to find the causes and improve the quality of your life.