In the U.S., one of the most commonly used treatments for chronic pain is opiate medication (such as oxycodone and hydrocodone). These potent drugs are highly effective for short-term use of relieving pain. However, when pain persists longer than six months, it is considered chronic, and opiate medication may become more harmful than helpful. Approximately 25 percent of people who are prescribed this medication will become addicted 1 . The U.S. uses almost 100 percent of the world's hydrocodone and 83 percent of the world's oxycodone 2 . Unintentional death from opiate use has increased four times from the year 1999 3. We will dive into how these types of medications can be doing more harm than good as well as natural ways to relieve pain.
How Opiates Make Pain Worse
Opiates work in the brain through neurons with opioid receptors. Neurons in the brain send chemical and electrical signals, which function to send information in order to make the body and brain work. Your body naturally produces opiates and these opiates work on specific neurons to inhibit pain. This explains why people sometimes do not feel pain after a traumatic injury, like losing a limb. These opiate neurotransmitters are only meant to work for short periods of time.
When opiates come from pain medication, they flood the brain with more opiates than it normally produces, resulting in a decrease in pain and sometimes even a "high." However, your brain has an amazing ability to adapt, which is often useful for keeping you alive. With long-term use of opiate medication, your body builds up a tolerance to the drugs, so a larger amount is required for the same effect on pain. You have also taught your body to rely on foreign substances to control pain, so your natural ability to fight pain has been damaged 4 . Occasionally, our brain overcompensates and this results in opioid-induced hyperalgesia, which is an increased pain response 5 . In effect, your brain is now more sensitive to pain because of these medications, especially during withdrawal after stopping opiate use.
Even with increased dosage of opiates, your body can become tolerate of the drug, so it no longer decreases pain. Because of this, people often continue to increase the amount of opiate medication they take, despite doctors' warnings. Eventually, the dosage can become so high that some people switch over to the stronger and illegal opiate, heroin, in order to get the same pain relief. Occasionally, people take too much opiate medication, which can result in death.
Effective Treatments
While opiates may be the easiest treatment for pain, they are by no means the most effective nor are they a solution. Opiate medications simply treat a symptom; because they do not affect the underlying cause of pain, they will never really make the pain go away. The first and most effective way to treat chronic pain is to treat the underlying problem. However, for many people with chronic pain, this is not possible.
The most effective method of managing pain is using a multidisciplinary or biopsychosocial method. This means combining traditional medical treatment with psychotherapy and lifestyle changes. The most effective non-medical treatments for chronic pain:
- Psychotherapy: There has been a strong association found between psychological distress and chronic pain. Psychotherapy for chronic pain can be more technical, such as cognitive behavioral therapy for chronic pain, relaxation training, and meditation. It can also be more geared towards emotional support, such as chronic pain support groups and Acceptance and Commitment Therapy.
- Physical Therapy: This consists of massage, stretching, and specific forms of exercise to strengthen muscles and improve flexibility.
- Anti-Inflammatory Diet: Often pain flareups are due to inflammation in the body and so eating a diet high in fruits and vegetables, low in processed foods and carbs, can help reduce pain.
- Exercise: People with chronic pain often become sedentary in order to avoid pain. This leads to muscle weakness and weight gain. Exercise has been shown to reduce inflammation as well.
- Biofeedback: Sensors are attached in order to monitor breathing, heart rate, muscle tension, skin temperature, and skin conductance. Participants are taught how pain and stress affect their body. They learn relaxation techniques to manage the pain, using the physiological feedback to guide them.
- Alternative Treatments: While there is little research on the efficacy of alternative treatments, they have demonstrated effectiveness for some people, anecdotally. These include chiropractic treatment, acupuncture, massage, reiki healing, and yoga.
Conclusion
Pain medication can appear to be an easy fix but the side effects can be unpleasant and the consequences of long-term use are dangerous. For many with chronic pain, opiate medication may stop working or even make pain worse. For some, it will cause addiction and even death. It is important that people living with chronic pain explore different treatments instead of relying solely on opiate medication. There is no one solution that works for everyone, so the key is to be persistent.
References
- CDC. Prescription Opioid Overdose Data. Retrieved from cdc.gov/drugoverdose/data/overdose.html
- International Narcotics Control Board Report 2008. (2009). Retrieved from books.google.com
- UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1). Retrieved from unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf
- Volkow, N. D. (2014, May 14). America's addiction to opioids: Heroin and prescription drug abuse. Retrieved from drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
- Arout, C., Edens, E., Petrakis, I., & Sofuoglu, M. (2015). Targeting opioid-induced hyperalgesia in clinical treatment: Neurobiological considerations. CNS Drugs, 29(6), 465-486. doi:10.1007/s40263-015-0255-x