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.

 

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