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The Bidirectional Connection: Chronic and Emotional Pain

The Endogenous Opioid System vs Medication?

An article published in the Annals of Family Medicine journal states that painkillers may not address all aspects of pain, and may add to dysfunction. In their abstract, pain experts Mark Sullivan and Jane Ballantyne, from the University of Washington School of Medicine, state, "The US opioid epidemic challenges us to rethink our understanding of the function of opioids and the nature of chronic pain. We have neatly separated opioid use and abuse as well as physical and social pain in ways that may not be consistent with the most recent neuroscientific and epidemiological research." Since emotional pain affects some of the same limbic brain centers as physical pain—like fibromyalgia, back pain, and headaches—opioids, although helpful short term, need to be more fully examined for long-term use.

Sullivan said that patient’s “social and emotional functioning is messed up under a wet blanket of opioids.” Painkillers used long term may “produce a state of persistent opioid dependence that suppresses the endogenous opioid system that is essential for human socialization and reward processing. Recognition of the social aspects of chronic pain and opioid action can improve our treatment of chronic pain and our use of opioid medications.” If long-term opioid use isn’t providing “clear improvement in pain and function, they need to taper down or switch to buprenorphine. If available, a multidisciplinary pain program using a case manager to monitor their care and well-being, similar to those for diabetes and depression care, may be of benefit.”

 

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