chronic pain addiction Archives - Minnesota Physical Medicine Blog

A newspaper headline read this week, “1 in 3 Medicare Patients took Opioids” in the last year. Is that as big a deal as the headline made it out to be? Probably not. If one starts to think about the article and read the whole story, it becomes ridiculous. The study being cited actually reports that 1 in 3 Medicare recipients overall received at least one prescription for an opioid medication in the last year. The article and the study indicated this was a major problem.

Some facts should be thought about when analyzing such a study. First, one in three people suffers from chronic pain. Further, chronic pain tends to be more common in the elderly and disabled, the very population that has Medicare. One prescription within a year’s time is probably not significant. Many people have significant medical procedures within one year, including dental procedures, numerous outpatient surgeries, or even painful diagnostic studies. Others have injuries that may be extremely painful for several days. The common thread is that all these things are appropriate for short-term opioid use to control pain. Obtaining one prescription within a year for a third of all Medicare patients would probably be very normal.

Interpreting The Stats

The focus of the study and the article is to emphasize how bad and problematic are opioids. If one stops and thinks for a second, making that conclusion on the basis of “1 in 3 Medicare patients have received a prescription for opioids in one year” is terrible. Acute pain is exactly what opioids are best used to treat, especially for just a few days. It would not be surprising to find out that 1 in 3 Medicare patients had a significant medical procedure for which an opioid was prescribed.

A more devastating fact should be that 1 in 3 people suffer from chronic pain. The causes of pain are extremely varied. The headlines of the paper are all about addiction. There are very few about how widespread pain is a problem. The big alarm is about death related to drug abuse. Addicts are obtaining billions of dollars for further treatment and research from the government. There are no headlines about how people struggle day to day with dealing with pain and still trying to continue with life.

Addiction to opioids and the increases in deaths is a problem. The solution in reality is probably to treat the true problem, which is the pain. Better pain medications that are not addictive definitely are needed. Research in the basic science of pain and how to prevent it is needed even more.

New research out of Northwestern University suggests that chronic pain can rewire your brain so a person actually becomes “addicted” to chronic pain.

The new research published in Nature Neuroscience examined how brain neurons in rats were affected by negative emotions and pain. When looking at the rodents, researchers noted that some rats experienced a hyper-excitable collection of neurons after an injury or pain. These neurons not only controlled some negative emotions, but their hyper-expression was also associated with a drop in the neurotransmitter dopamine, which plays a large role in our reward motivation. In essence, the brain was misconstruing why these neurons were firing, and it slowly became addicted to their hyper-expression. In essence, your body becomes addicted to pain.

“The study shows you can think of chronic pain as the brain getting addicted to pain. The brain circuit that has to do with addiction has gotten involved in the pain process itself,” explained corresponding author A. Vania Apkarian, PhD, adding that pain is both sensory and emotionally based.

New Understanding, New Solution?

With their new understanding of how some people’s body’s perceive pain, Dr. Apkarian began working on new ways to treat chronic pain. Using a combination of two different drugs, they were essentially able to rewire the brain so it stopped seeing pain as a rewarding behavior.

“It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad. By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models,” said the study’s lead author Dr. D. James Surmeier. “The question now is whether it will work in humans.”

The team hopes to take their study to the next stage and see if it produces a similar positive affect in humans whose brain’s have been affected by chronic pain.