Pain management and the opioid crisis - Podcast
Apr 14, 2022
Click on the link to listen to Episode 3 of What the Kale. Devin Stone is naturopathic doctor taking a functional medicine approach to health care. I had the honor of being invited onto his podcast.
We discussed pain management and the opioid crisis, why long term use of opioids are ineffective for chronic pain management, and natural solution options that minimize medication usage and maximize results for a pain free life.
Why is chronic opioid use ineffective for chronic pain?
Excellent question!
We've learned a lot over the last 20 years of research into chronic pain management. We understand better now exactly what opioids do to the body long term.
According to the CDC, from 1999-2019, nearly 500,000 people died from an overdose involving an opioid, including prescription and illicit opioids.1
The number of drug overdose deaths increased by nearly 5% from 2018 to 2019 and has quadrupled since 1991. Over 70% of the 70,630 deaths in 2019 involved an opioid.
First of all, what is pain?
As defined by the International Association for the Study of Pain, it is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Pain is a normal, healthy response that is a defense mechanism. It tells you to stop doing what you are doing, as it may cause harm or damage.
This can be further divided into categories such as: Nociceptive pain (pain from an injury or stimulus), Neuropathic pain (pain from a compressed nerve cell), Psychogenic pain (pain from mental, emotional or behavioral factors).
Acute pain (usually due to an injury) heals and resolves completely after about 3 months. Pain becomes chronic, if still feeling pain after more than 3 months and usually encompasses nociceptive, neuropathic, and psychogenic pain components.
Do opioids work?
Opioids work well for short-term, acute injuries, or pain from a surgical procedure. They are also helpful for treating cancer related pain.
Initially, opioids produce a strong sense of euphoria. The brain is flooded with the “happy” hormones, like dopamine and serotonin. Opioids interact with the Mu receptors in the body, dulling the pain sensation in the brain. Over a prolonged period of time of use, the body begins producing more receptors for the opioids to interact with, (mu receptors) which leads to tolerance and an increased need for more opioids. This causes an increase in usage to reach the desired effect putting a person at extreme risk for over dose or death.
Your body will eventually deplete the stores of the dopamine and serotonin hormones which can lead to depression, insomnia, paranoia, confusion, hallucination, mood swings, and memory loss.
Long-term use of opioids can trigger structural and functional changes in the brain that cause users to lose much of their ability to cope with pain naturally without the use of pain medication. In other words, long-term opioid use has been found to cause significantly decreased pain tolerance. Additionally, users begin to experience pain more intensely since they don’t consistently have high levels of opiate painkillers in their systems.2
To summarize: Your body produces more Mu receptors increasing your need for opioids. Your body is depleted of the happy hormones (dopamine and serotonin). Your brain structure and function changes so your ability to cope with pain is less, making you hurt more.
Why are opioids so dangerous?
Simply put, they cause respiratory depression. This means they suppress your ability to breathe. Breathing is an automatic response that is controlled by your brain. How is it that you breathe at night while you sleep? Opioids block this automatic response in your brain telling your body to breathe. Opioids cause sedation and then can cause you to stop breathing. Even if you have tolerance built up, when a dose is increased you are now at risk again for respiratory depression and increased side effects.
Tolerance vs. Addiction
These are two different things, but one can lead to the other. Tolerance occurs when the opioid is no longer effective and the dose needs to be increased to obtain relief of symptoms. Addiction is more about behaviors associated with getting more opioids, possibly even buying them off of the street, to maintain the euphoria that is associated with opioid use. Tolerance can lead to addiction, and withdrawal can happen to anyone who is tolerant or addicted to opioids.
It is never recommend to just stop taking opioids if tolerance or addiction has occurred. Withdrawal can be dangerous and needs to be done with the guidance of a doctor.
Guidelines:
Have become pretty strict and the long-term use of opioids for chronic pain is not recommended due to the potential for overdose. It's an unfortunate situation, as many people have become unknowingly addicted to these medications due to the push for opioids being safe and effective medications for chronic pain. Purdue Pharma and the Sackler family are to pay out $Billions to settle an opioid lawsuit.3
Treatment Options:
In the chronic pain management industry the push is for natural solutions, non-opioid medication therapies, procedures, injections, radiofrequency ablation (RFA), or possible surgery.
Natural solutions include myofascial release, massage therapy, reflexology, acupuncture, physical therapy, chiropractic care, exercise, anti-inflammatory diets, sleep, treatment for emotion trauma and depression.
We have better understanding now that chronic pain mastery requires a multimodal approach to improve functionality of the musculoskeletal system, treat a traumatized brain, and provide proper nutrition so support the body from the inside out.
Are you wanting to get off opioids and start living a healthier, pain FREE life?
Take a listen!
Nicole
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