Why Opioids Cannot Fix Chronic Pain

Summary: Study explores the role the reward system plays in chronic pain, finding emotional and physical pain are bidirectional. Opioids, researchers report, ultimately make things worse.

Source: University of Washington

A broken heart is often harder to heal than a broken leg. Now researchers say that a broken heart can contribute to lasting chronic pain.

In a reflections column published Dec. 21 in the Annals of Family Medicine, pain experts Mark Sullivan and Jane Ballantyne at the University of Washington School of Medicine, say emotional pain and chronic physical pain are bidirectional. Painkillers, they said, ultimately make things worse.

Their argument is based on new epidemiological and neuroscientific evidence, which suggests emotional pain activates many of the same limbic brain centers as physical pain. This is especially true, they said, for the most common chronic pain syndromes – back pain, headaches, and fibromyalgia.

Opioids may make patients feel better early on, but over the long term these drugs cause all kinds of havoc on their well-being, the researchers said.

“Their social and emotional functioning is messed up under a wet blanket of opioids,” Sullivan said.

The researchers said new evidence suggests that the body’s reward system may be more important than tissue damage in the transition from acute to chronic pain.

By reward system, they are referring, in part, to the endogenous opioid system, a complicated system connected to several areas of the brain, The system includes the natural release of endorphins from pleasurable activities.

When this reward system is damaged by manufactured opioids, it perpetuates isolation and chronic illness and is a strong risk factor for depression, they said.

“Rather than helping the pain for which the opioid was originally sought, persistent opioid use may be chasing the pain in a circular manner, diminishing natural rewards from normal sources of pleasure, and increasing social isolation,” they wrote.

This shows a man holding his head
Opioids may make patients feel better early on, but over the long term these drugs cause all kinds of havoc on their well-being, the researchers said. Image is in the public domain

Both Sullivan and Ballantyne prescribe opioids for their patients and say they have a role in short-term use.

“Long-term opioid therapy that lasts months and perhaps years should be a rare occurrence because it does not treat chronic pain well, it impairs human social and emotional function, and can lead to opioid dependence or addiction,” they wrote.

What Sullivan recommends is if patients are on high-dose long-term opioids and they are not having 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.

About this pain research news

Source: University of Washington
Contact: Bobbi Nodell – University of Washington
Image: The image is in the public domain

Original Research: Closed access.
When Physical and Social Pain Coexist: Insights Into Opioid Therapy” by Mark D. Sullivan and Jane C. Ballantyne. Annals of Family Medicine


When Physical and Social Pain Coexist: Insights Into Opioid Therapy

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. Physical injury and social rejection activate similar brain centers. Many of the patients who use opioid medications long term for the treatment of chronic pain have both physical and social pain, but these medications 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.

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  1. I totally disagree I’m a 25 year opiate of some sort user for CRPS. I’ve tried everything and opiates are only thing that calms my pain. I was told I’d never be pain free bc I’d need to be on vary high doses to do so! Addiction and chronic pain are two separate issues! Please stay in your lane. Legacy pain patients need medically managed opiates to somewhat function with some normality! It’s horrific what is happening with pain patients. 25 years in I cut my opiate intake by 2/3 after scs but still require opiate pain control! Please stop spreading this false narrative!!!!!!

  2. You people need to suffer now! I pray you do and everyone who has had a hand in taking pain patients medications away! I hope you and yours suffer just as the patient’s lives you have ruined or are helping to ruin with these wrong outlooks. I pray every one of you responsible for not fixing our medications back to what they were before the CDC and doctors and politicians took it away suffer quickly and long term just as I and many others have. Sincerely, PeggySue1371

  3. Propaganda intended to focus public policy on addiction but once again we have overwhelming evidence that prescription opioids are not correlated with overdose fatalities because those fatalities are driven by illicit fentanyl and other street drugs that cracking down on pain patients is having the opposite to the desired effect and so overdoses goes up as restrictions crack down on pain patients. Government is not the solution. Government IS THE PROBLEM.

  4. These authors have no training in pain research and are biased against patient who have successfully used opioids for decades to manage chronic pain. Most people do not have hope of “curing” chronic pain, but still require pain management.

    JB and MS should have been conflicted out of this publication as she received hundreds of thousands in expert witness income from Linda Singer, who pitched the opioid MDL to the Attorneys General. Both are card-carrying members of PROP, a harmful anti-patient group. Shame on this journal for publishing this garbage.

  5. This article explains what you shouldn’t do but gives no realistic alternatives other than the nebulous “management” of pain that is, in this context, meaningless. If a person with long term severe pain is not to receive treatment that decreases that pain their options appear to be to either live in severe and debilitating pain, or suicide. Given the number of people in severe pain to opt for suicide, is this to be considered as a viable option? If not, what is the option? Because what I hear is a lot of people who’ve never experienced that kind of pain telling people who suffer with it to “get over it”.

  6. Seems to be quite the opposite for me personally. After many years of high dose around the clock opioids for chronic pain I was force tapered due to CDC guidelines in 2018. I was tapered so low so fast that the remaining medication I was offered was completely ineffective. I’ve been drug free since and have seen no point in seeing a dr. I’ve suffered from everything you described in this article only since being removed from the medication that was helping me to have some quality of life that I no longer have. I suffer daily chair and bed bound with no help only to read articles like this disagreeing with my life as I know it consistently.

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