In Andrew Sullivan’s sprawling New York Magazine take on the voracious nature of the opioid crisis – “The Poison We Pick” – he posits that the “drugs now conquering America are downers: They are not the means to engage in life more vividly but to seek a respite from its ordeals.”
Perhaps that explains those who experience chronic pain – a terrible disease that makes everyday tasks like buttering toast and fastening a seat belt – an agonizing experience for which pain pills serve as the only form of respite. In the midst of a nation wrestling with a growing epidemic, pain pills may be easy, however, the addiction it causes in chronic pain sufferers does more harm than good.
In the United States, chronic pain affects 133 million Americans; and 65% of Americans seek care for persistent pain at some point in their lives, reports the American Academy of Pain Medicine. As such, chronic pain affects more lives than diabetes and heart disease combined. This is big business for the healthcare industry – an estimated $560-635 billion is spent annually to manage pain, including healthcare expenses, lost income, and lost productivity at work and home, per Medline Plus, a publication of the National Institutes of Health.
In lieu of these growing numbers, one must be able to distinguish between acute and chronic pain. Acute pain is short term, typically brought on by a physical ailment such as inflammation or injury and clears up when the source is treated and heals – typically a 90 day window. Acute pain is also clearly targeted and has distinct warning and protective functions, making it easier for doctors, nurses and caretakers to provide healthcare that targets acute-related pain at the source.
Chronic pain, however, is long-lasting, generally over three months of persistent pain. Per Medline Plus, chronic pain is believed to be a disease that causes changes in the nerves and persists long after the initial source of the pain heals. Further complicating matters is that chronic pain becomes uncoupled from causation, loses its warning and protective functions with time, and transforms into a special therapeutic challenge.
Though injury can develop into chronic pain, the most common types Americans experience are headaches and migraines, lower back pain, arthritis, fibromyalgia, carpal tunnel syndrome, and pelvic and muscle pain. There are a variety of treatment options for these types of chronic pain, but the dangerous type of treatment came in the form of painkillers or opioid prescriptions. With so many Americans experiencing all types of chronic pain, pain medications were over-prescribed, and addiction took root. To make matters worse, when opioid painkillers are consistently used (and/or abused) over time, a unique set of problems settles in and may exacerbate the pain.
One such issue is hyperalgesia, a condition where a person becomes overly sensitive to pain. And doctors and researchers have linked this phenomenon to opioids. Essentially, the prolonged use of medication to treat pain develops a change in the person’s nervous system and brain chemistry, so that their pain threshold goes down and sensitivity goes up.
“Opioid-induced hyperalgesia is not fully understood,” says Jay Tracy, a clinical psychologist at the Chronic Pain Rehabilitation Program and at the Phoenix Center for Pain Services in Golden Valley, MN. “It is apparent that a person can become hypersensitive and hyper-responsive to painful stimuli due to the use of opioids.” It’s a catch twenty-two: more pain sensitivity prompts the person to increase pain medication, fanning the flames of addiction and hyper sensitivity to pain. As such, Dr. Tracy says “clinicians and patients should be aware of its expression, risks, and implications when using opioids.”
With the challenge of understanding chronic pain and its many confounding attributes, new research has discovered the pain to brain relationship, a breakthrough in cracking the code of pain and the body’s natural responses. “When we think of chronic pain, we think of an afflicted body part… an aching lower back, a throbbing shoulder,” writes Morgan Ingemanson for eVox Brain Map.
“But to effectively treat chronic pain, new research says we should be looking to the brain instead of the body.” As such, this research may lead to complementary and/or alternative forms of treatment that can better treat the disease and save lives from opioids.
Most chronic pain causes changes in the nervous system. When this happens, people who experience chronic pain become more sensitive to pain because the nervous system is on high alert (which may also trigger hyperalgesia in some). And because the human brain works in tandem with the nervous system, pain is fully connected to the brain. According to eVox Brain Map, here are the ways pain causes changes in the brain:
- Brain chemistry. Neurotransmitters are chemicals in the brain that stimulate activity and inhibition. Normal function of neurotransmitters creates a balance in step with a healthy and high functioning body. But when chronic pain disrupts this balance, stimulating the brain to make abnormal levels of neurotransmitters, the chemistry of the brain becomes altered, more sensitive to pain, and reinforces this destructive cycle.
- Brain structure. The latest neuroimaging studies have shown that “chronic pain can alter the size of certain brain regions and change the connectivity between these regions.” As such, symptoms can arise that further compound the problem. Fear, anxiety and depression are common in patients who experience chronic pain because the disrupted brain structure triggers these regions of the brain.
- Brain activity. Although pain feels the same from acute to chronic, researchers have found an emotional response tied to chronic pain because the brain processes pain differently in these two different stages of pain. As such, researchers have discovered that emotion – natural chemicals and hormones in the body that generate feeling – drives pain. “This might explain why treatment that work well for acute pain patients don’t provide any relief for chronic pain patients with the same injury.”
The good news is that the human brain is malleable – scientists call this neuroplasticity – as it can be molded and changed throughout a person’s life and even return to normal functioning states. At the heart of tapping into plasticity and rewiring the brain to feel pain at normal levels is “Goldilocks.”
As in the fairy tale, Goldilocks did not want a bowl of porridge too hot or too cold but just the right temperature. This idea applies to chronic pain patients working through their pain. For a patient going through physical therapy on an injured leg, they have to relearn how to fully extend and articulate this limb. This requires them to learn that too little work will keep them in their chair and too much will overextend the leg. As their brain relearns full function and the nervous system stimulates levels of pain, a balance will take place – just the right temperature for the porridge – to give the patient hope and healing. And as emotion is in lock-step with pain, a boost of confidence and the feeling that you are making progress returns the brain chemistry to normal function.
There are a number of therapies for people who experience chronic pain. Physical activity like yoga classes, biking, hiking, rock climbing, frisbee, juggling and any other number of outdoor activities are a great start. Meditation, mindfulness and breathing exercises are also useful in concentrating the mind on the present, in effect redirecting those neural pathways toward healthy pain levels. Acupuncture, aquatic therapy, Qigong, music, spinal manipulation are all new types of therapies that are paving the way for chronic pain sufferers to find healing.
If you or a loved one you know is experiencing chronic pain, please reach out to me about ways to break through the cycle of addiction from pain pills and find healing in treatment options.