Should Opioids Be Prescribed for Chronic Pain?

It is said that a broken heart is harder to heal than a broken leg. The researchers have now found that a broken heart can contribute to lasting chronic pain.

The research conducted by pain experts Mark Sullivan and Jane Ballantyne at the University Of Washington School Of Medicine is published in the Annals of Family Medicine

‘Long-term use of opioids for chronic pain can impair social and emotional function and also precipitate chronic illness and isolation. It also increases the risk of depression and addiction. The experts recommend the use of opioids only for a short duration.’

The researchers have stated that emotional pain and chronic physical pain are bidirectional and painkillers can ultimately make things worse.

They based this new argument on the epidemiological and neuroscientific evidence that suggests emotional pain activates many of the same limbic brain centers as physical pain. This is especially true for the most common chronic pain syndromes- headaches, back pain, and fibromyalgia.

Even though opioids can make a patient feel better early on, but in the long term these drugs can cause all kinds havoc on the well-being of the patient.

Sullivan said, "Their social and emotional functioning is messed up under a wet blanket of opioids."

A new evidence suggests that the body's reward system, which uses dopamine, may be of more importance than tissue in the transition from acute to chronic pain.

The reward system includes the release of endorphins from pleasurable activities. It is related to the endogenous opioid system that connects several areas in the brain.

The opioid medications damage the reward system and they can precipitate isolation and chronic illness. There is also a strong risk for depression.

The researchers said, "Rather than helping the pain for which the opioid was originally sought, persistent opioid use may be chasing the pain in a circular manner, diminishing natural rewards from normal sources of pleasure, and increasing social isolation."

The researchers prescribed opioids only for short-term use.

The researchers state that long term use of opioid therapy that lasts months or years should be rare as it does not treat chronic pain but it can impairs human emotional and social function. It also leads to opioid addiction or dependence.

The experts recommend that patients on high-dose long-term opioids not having any improvement in pain and function can be switched to buprenorphine. The patients can also be enrolled in a multidisciplinary pain program using a case manager to monitor their care and well-being, similar to those for diabetes and depression care.

Source: Medindia