10 May How can opioids negatively impact your pain, brain, and functioning?

Opioids over the last several years have come under great scrutiny, and for good reason. Historically speaking, physicians were educated, that the risk of addiction from chronic opioid use for the treatment of (non-cancer related) chronic pain was less then 1%. This statistic has been debunked, and may in part have arisen out of some unscrupulous industry practices. A vigorous re-education process is currently underway.

Today in some counties around the United States of America we are seeing deaths from prescription opioids and the synthetic opioid “Heroin,” every 30+ hours. In fact while the United States has ~5% of the worlds population, we as a society use ~90% of the worlds Hydrocodone (a prescription opioid).

This has lead to numerous administrative, medical, and legal bodies declaration “Of A War on Opioids.” Recent guidelines released by the Center for Disease Control (CDC), place thresholds and dosing triggers, to provide guidance to prescribers.

A thorough literature review pulls back the curtain even more, and sheds light on this historically troubling trend. Many patients with chronic pain syndromes and non-cancer related pain conditions, irrespective of injury, have co-existing suboptimal brain functioning. What does that exactly mean you might ask? Well researchers have studied the brains of people with chronic pain using MRI’s, PET scans and other imaging and neuroscience modalities. And discovered that the effects of chronic pain on the brain, are very similar to depressive disorders.

The result is that people suffering with chronic pain, have brains that in many instances closely resemble the brains of those struggling with chronic depressive disorders. Brain imaging shows decreased cortical (thinking) brain functioning, and increased limbic (emotional) brain functioning. Adding an opioid medications too the brain in these circumstances; is in many respects like adding gasoline to a burning fire! It makes the fire (in this case the pain) burn!

Not to mention, the longer one consumes opioids to treat pain; the more a person will require these medication over time, in order to achieve the same amount of pain relief. This is what is classically known as tolerance. There is some research that suggests that after 1 week of opioid consumption, tolerance can occur.

In addition, there is very little evidence supporting the notion that chronic opioid use, actually results in an overall improvement in a persons function. Some studies show that by slowly decreasing opioid, use functioning actually can improve by as much as 30% with no change in underlying pain.

The net result – opioids are not favorable for the treatment of non-malignant and non-cancer related pain, and should be avoided in favor of other medications and modalities, when symptoms require treatment.