Self-Motivation
David Goggins
Former Navy Seal
Career Development
Bryan Cranston
Actor
Critical Thinking
Liv Boeree
International Poker Champion
Emotional Intelligence
Amaryllis Fox
Former CIA Clandestine Operative
Management
Chris Hadfield
Retired Canadian Astronaut & Author
Learn
from the world's big
thinkers
Start Learning

Pain Management Should Soon Be Possible Without Fear of Addiction or Overdose

60% of pain patients find that tolerance buildup significantly impedes their treatment over time. 

 

A bottle of prescription painkillers spilling out.

There is an epidemic going on today that you hear almost nothing about. Yet it effects around 50 million Americans, according to the National Institutes of Health (NIH). That’s more than those diagnosed with diabetes and cancer combined. It’s a chronic pain epidemic and it’s everywhere. Such pain is not only devastating for the person and their family, it is also the leading cause of disability. A higher number of cases puts more of a burden on the healthcare system and hampers economic growth. So it isn’t only the person and their closest kin who suffer, but society as a whole.


Unfortunately, therapies haven’t changed much over a hundred years or more, as little is really known about the phenomenon of pain itself. There are really two main options in terms of therapy. The first is non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Bayer), acetaminophen (Tylenol), and naproxen (Aleve). There are stronger prescription varieties of these as well.

The second option is opioid painkillers. Derived from opium, the most common types prescribed are morphine, OxyContin, Vicodin, Percocet, oxycodone, hydrocodone, and fentanyl. Of course there are many others. Though effective in the short-term, 60% of patients find that building up a tolerance significantly impedes treatment over time. Unfortunately, three to four percent of Americans receive morphine or one of its derivatives to manage severe or chronic pain, long-term.

In the last decade, an increase in the prescribing of opioids has followed the pain crisis’s upward trend. When taken as prescribed, opioids are safe and effective. But as the body begins to build up a tolerance, pain tends to bleed through. Oftentimes, increasing dosage is not recommended past a certain point. Alternative therapies such as acupuncture, tai chi, yoga, and physical therapy are usually proposed alongside opioids. Even so, patients don’t always find these options effective.

Cupping is the latest trend in alternative therapes. But many of these don’t reduce pain significantly enough.

Medical marijuana advocates have suggested cannabis therapy alongside opioids. Some studies have found that it does not increase the risk of addiction or overdose, and in fact gives additional pain relief. In fact, one study out of the University of Michigan found a 64% reduction in opioid use, when medical marijuana was made available to pain patients. But for many, this option may not be viable.  

For those patients with bleed through pain, the motivation to take more than prescribed is great. Though they may find relief in the near term, the patient will soon find themselves increasing dosage once again when tolerance has increased, and so inching ever closer toward an overdose. It is through this process, and through teens and young adults swiping pills from medicine cabinets, that the prescription opioid epidemic has taken hold.

Medical marijuana may help. But it’s not a viable option for all patients for a number of reasons.

2.1 million in the US were addicted to prescription painkillers in 2012, according to the NIH—the latest numbers on record. And overdose deaths have increased fourfold since 1999. It is also fueling a heroin epidemic, as the street drug is less expensive and more readily available.

Big pharma has responded by offering extended release opioids, in an attempt to give patients more relief and discourage them taking more than prescribed. Other drugs have abuse-deterrent features, such as pills one is unable to crush, and so cannot snort or use intravenously. Yet, many see this as a technological fix, putting a Band-Aid on an already out-of-control problem. Also, it does not address the issue of bleed through pain.

Besides being little understood, not enough research is conducted to learn more about chronic pain. Today, the race is on to find ways to overcome these problems, and deliver better pain relief to those who are suffering. One new study, published in the journal Neuropsychopharmacology, has located the brain mechanism that causes opioid tolerance. Researchers have even devised a way to overcome it.

An opioid overdose kit. These are ubiquitous now across the country due to the opioid addiction epidemic.

Investigators from Emory and Georgia State Universities found, for the first time, how morphine tolerance comes about. This is an inflammatory response triggered when chemical messengers called cytokines are released inside the brain. By blocking cytokines, researchers say pain could be relieved consistently with morphine over time, at only half the dosage. These scientists were able to illustrate how the inflammatory response occurred in rats’ brains, and that blocking cytokines could undermine tolerance.

The mechanism for tolerance buildup works like this. Over time, morphine interferes with homeostasis, or the body’s ability to manage functions in a rhythmic and timely manner. Since it no longer recognizes pain, the body moves to rid itself of this foreign agent and reestablish balance within the system. To do that, it triggers the immune response, which causes inflammation—used to drive the agent out.

Another find, tolerance occurs quickly. One dose each day for three days was enough to cause the tolerance response to kick in. When rats were given a drug that blocked inflammation, tolerance to morphine plummeted. Researchers concluded the study by writing, “Our findings provide a novel pharmacological target for the prevention of opioid-induced immune signaling, tolerance, and addiction.”

To learn more about the prescription painkiller epidemic click here: 

LIVE ON MONDAY | "Lights, camera, activism!" with Judith Light

Join multiple Tony and Emmy Award-winning actress Judith Light live on Big Think at 2 pm ET on Monday.

Big Think LIVE

Add event to calendar

AppleGoogleOffice 365OutlookOutlook.comYahoo

Keep reading Show less

Neom, Saudi Arabia's $500 billion megacity, reaches its next phase

Construction of the $500 billion dollar tech city-state of the future is moving ahead.

Credit: Neom
Technology & Innovation
  • The futuristic megacity Neom is being built in Saudi Arabia.
  • The city will be fully automated, leading in health, education and quality of life.
  • It will feature an artificial moon, cloud seeding, robotic gladiators and flying taxis.
Keep reading Show less

Study details the negative environmental impact of online shopping

Frequent shopping for single items adds to our carbon footprint.

A truck pulls out of a large Walmart regional distribution center on June 6, 2019 in Washington, Utah.

Photo by George Frey/Getty Images
Politics & Current Affairs
  • A new study shows e-commerce sites like Amazon leave larger greenhouse gas footprints than retail stores.
  • Ordering online from retail stores has an even smaller footprint than going to the store yourself.
  • Greening efforts by major e-commerce sites won't curb wasteful consumer habits. Consolidating online orders can make a difference.
Keep reading Show less

Childhood sleeping problems may signal mental disorders later in life

Chronic irregular sleep in children was associated with psychotic experiences in adolescence, according to a recent study out of the University of Birmingham's School of Psychology.

A girl and her mother take an afternoon nap in bed.

Personal Growth
  • We spend 40 percent of our childhoods asleep, a time for cognitive growth and development.
  • A recent study found an association between irregular sleep patterns in childhood and either psychotic experiences or borderline personality disorder during teenage years.
  • The researchers hope their findings can help identify at-risk youth to improve early intervention.
  • Keep reading Show less
    Videos

    Why do people believe in conspiracy theories?

    Are we genetically inclined for superstition or just fearful of the truth?

    Scroll down to load more…
    Quantcast