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Chronic Pain and the Opioid Epidemic

September 16, 2019 | 11:21am

September is Pain Awareness Month, and we are dedicating the entire month to discussing all things pain starting with the current opioid overdose crisis that is going on in the country and  some non-addictive options.

If you’ve been paying attention to the news lately, you’ve probably heard about the recent opioid epidemic. In 2017 alone, more than 70,000 Americans died of opioid-related drug overdoses – a 45% increase from the previous year. The opioid epidemic has become such a big problem, that in 2017 the U.S Department of Health and Human Services declared it a public health emergency and proposed a 5-point strategy to address the crisis that’s still in action.

Synthetic (man-made) opioids are prescribed to manage pain after surgeries and are also sometimes prescribed to patients who suffer from chronic or severe pain. However, since the 1990s, illicit opioids manufactured by illegal pharmaceutical laboratories have also become a popular recreational drug.

Common drug names and brand names of opiods include; Oxycodone, Hydrocodone, Pseudoephendrine, Morpine, Fentanyl, Codeine, Methadone, Buprenorphine, and Tramadol to name a few.  The main problem with these drugs is that they are highly potent and extremely addictive; one of the most powerful synthetic opioids, fentanyl, is 50 times stronger than heroin and 100 times stronger than morphine. In the United States, more fatal drug overdoses are caused by fentanyl and other synthetic opioids than any other types of drugs.

Opiod Bottles

 

Where Do Opioids come From?

Though most opioids used today are made synthetically, natural opioids (called opiates) are derived from the opium poppy plant. Experts believe that the use of opiates as pain relievers and sleeping aids date back thousands of years to around 3,400 B.C.

In the 1700s, the British empire began exporting Indian opium to China, which caused a serious addiction crisis among Chinese people. The Opium Wars occurred in the mid-19th century as a result of the Chinese government’s decision to ban opium use within its borders and the British empire’s efforts to keep smuggling it into Chinese territory.

During the late 19th century, researchers were able to isolate the specific compound of the poppy plant that provides pain relief and makes people high – they named it morphine after Morpheus, the god of dreams. Later on, heroin, the synthetic derivate of morphine, was offered as a cough suppressant and a non-addictive alternative to morphine. Years later heroin would be proven to be even more dangerous and additive than morphine.

In 1914, the Harrison Narcotics Act in the US banned the recreational use of opioids and made them available by prescription only. By 1986, the World Health Organization recommended opioids only as a last resort painkiller and advised medical professionals to look for non-addictive treatment options for pain.

What Are the Effects of Opioids on the Body?

When opioids enter your system, they activate a series of receptors – called opioid receptors – in different parts of the body including the brain, the gut, and the spinal cord. Activated opioid receptors stop pain signals from reaching the brain, which means that while they don’t fix the root cause of the pain, they keep your brain from realizing that it is there.

Anyone who takes opioids, either for medicinal or recreational reasons, is at risk of developing an addiction. Opioids are extremely addictive for a couple of different reasons; for example, they temporarily keep you from feeling physical pain. They also release dopamine and endorphins, aka the “happy neurotransmitter,” which create a sensation of relaxation and well-being for a short amount of time. Once the effect of opioids wears off, the brain starts craving those pleasurable feelings all over again, which leads many people to misuse or abuse their prescriptions.

When Are Opioids Prescribed?

Painkillers like Vicodin or OxyContin are prescribed to patients who suffer from chronic or severe pain. Prescription opioids can help relieve painful headaches like migraines, pain resulting from accidents, surgeries, toothaches, and are sometimes prescribed to cancer patients to manage pain during or after treatment.

Back Pain

What Are Some Non-Addicting Alternatives for Pain?

Almost everybody has experienced some sort of extreme pain or discomfort at some point or another. Maybe the worst pain you’ve ever experienced was when you fell down and broke your ankle, or perhaps you suffer from excruciating chronic pain every day. But regardless of its origin, there’s one thing that’s for certain: being in pain is no laughing matter.

When doctors prescribe opioids, they are intended to be used only for a short period of time; as we mentioned before, prescription painkillers don’t treat the underlying cause of pain, and they only block pain signals temporarily. This means that taking opioids for will not make your pain go away forever, and you will still feel it once the effect wears off.

Many people believe that only people who use illegal drugs can develop an addiction, but the truth is that anybody who takes opioids, legally or illegally, is at risk. In fact, according to a poll conducted by the National Safety Council, nine out of every 10 painkiller users are not concerned about developing an addiction, even though research suggests that 80% of heroin users first became addicted to prescription painkillers.

Of course, this doesn’t mean that 80% of people who take prescription painkillers will become addicted or transition to heroin, but it is important to know and understand the risks involved with taking these potent medications.

Whether you suffer from chronic pain or you are getting over a painful injury, these are a few effective non-habit-forming alternatives to opioids that you can try for managing your pain. However, remember that it is always best to consult your doctor before you start any new type of treatment.

 

NSAIDs

NSAIDs, also known as nonsteroidal anti-inflammatory drugs are the most prescribed pain relievers in the world. Some of the most popular types of NSAIDs are ibuprofen, aspirin, and naproxen and they are typically offered over-the-counter or by prescription depending on the dose.

NSAIDs reduce pain by blocking some of the chemicals that trigger inflammatory responses in the body. These types of medications are usually effective in people who have arthritis, joint pain, muscle pain, tooth pain, and back pain. The chronic use of NSAIDs however, can lead to side-effects such as kidney or liver damage, stroke, bleeding, ulcers, and increased cardiovascular risk. Over use of OTC drugs for migraine sufferers can also lead to “rebound headaches” or medication overuse headaches.

 

Physical Therapy

When your pain is so unbearable that it keeps you from living your life, taking painkillers might seem like the only option. However, taking pain relievers without addressing the root cause of the pain makes for a dangerous precedent. In addition to being potentially addictive, painkillers can cause a number of side effects that will ultimately make the cure worse than the disease.

Some of the most common sources of pain (e.g. post-surgical or post-trauma pain, arthritis, lower back pain, and muscle aches to name a few) can be managed and even resolved with a combination of medications and physical therapy.

Physical therapy is a type of treatment that aims to preserve, recover or enhance movement and physical function. During the course of several physical therapy sessions, an expert will help you regain strength and reduce pain by performing hands-on exercises and teaching you pain management strategies. People with any of these problems can benefit from physical therapy:

  • Arthritis
  • Back pain
  • Carpal tunnel syndrome
  • COPD or cystic fibrosis
  • Fractures
  • Paralysis
  • Post-surgical pain
  • Sports-related injuries
  • Sprains
  • Stroke or other neurological conditions

 

Cognitive Behavioral Therapy

When you are in constant pain, it can feel like you’ve lost control of your life. In fact, 30 to 50% of people who suffer chronic pain also have depression or anxiety, and to make matters worse, research has shown that depression seems to worsen pain. But the connection between depression and chronic pain seems to be even more complex; depression and anxiety have also been shown to cause chronic pain in some individuals.

Cognitive behavioral therapy (CBT) is a form of psychotherapy that can help you reprogram how you think about and experience pain. This type of therapy is based on the notion that our thoughts (cognition) influence our actions (behaviors) and physical sensations, so by modifying the way that we think, we can also change what that we feel or how we respond to pain. The primary goal of CBT is teaching you strategies to cope with your pain so it doesn’t take over your entire life.

CBT has been proven effective for many people with chronic headaches and migraines, arthritis pain, and fibromyalgia among others.

 

Natural Options

Let’s be honest, when we are in pain we want it to stop, and we want it to happen fast, so our first impulse is almost always to reach for the medicine cabinet. However, it is important to remember that the long-term use of medications can lead to side effects. The following are natural ingredients that have been proven effective for reducing inflammation and relieving pain:

Turmeric: Derived from the Curcuma longa plant, turmeric has been used for thousands of years in Eastern medicine as a natural anti-inflammatory agent. The key chemical in turmeric is curcumin. Studies have shown that curcumin has anti-inflammatory properties and modifies immune system responses. It has been known to beneficial for sufferers of arthritis and cystic fibrosis.

Ginger:  Recent research studies have shown that ginger can help reduce inflammation in people with arthritis and joint pain. Ginger contains more than 200 substances in its oils, which is why it has so many different uses. It has been used medicinally for thousands of years in Ayurvedic medicine in India and has anti-inflammatory, anti-ulcer and antioxidant properties. Ginger has been known to be beneficial for arthritis sufferers because it blocks the formation of inflammatory compounds (prostaglandins and leukotrienes) and also has antioxidant effects that break down existing inflammation and acidity in the fluid within the joints.
Boswellia extract: also known as Indian frankincense, Boswellia extract is a known natural anti-inflammatory and analgesic that has shown to be very beneficial for patients suffering from arthritis.

Feverfew: This fantastic plant was once dubbed the “medieval aspirin” because of its ability to reduce fever. Feverfew is a popular herb known to be beneficial for migraine, and arthritis sufferers. Scientific studies have shown feverfew helps to maintain normal cerebrovascular tone and function by inhibiting platelet aggregation (clumping together of blood platelets) and the release of serotonin from platelets and polymorphonuclear leukocyte granules. It has also been shown to inhibit pro-inflammatory prostaglandin synthesis and the release of arachadonic acid. Each of these phenomena is associated with migraines.

Prescription opioids are not the only way to manage pain. Safer alternatives like CBT, physical therapy, and natural remedies can help you ease your pain and improve your quality of life. However, as always it is important to talk to your doctor about your symptoms and your options. If your doctor prescribed opioids to help you deal with your pain, it is important to pay attention to his or her recommendations and only take them for the recommended amount of time.

To the Best of Health,

 

The MigreLief Team at Akeso Health Sciences

Migraines Take Toll on Mood and Can Lead to Depression & Anxiety

September 8, 2019 | 11:20pm

Migraine is very disabling, which takes a toll on mood which can lead to depression and anxiety.

As if living with the debilitating pain and other disturbing symptoms of chronic migraine wasn’t enough, combine it with a psychiatric disorder and quality of life drastically declines for many migraineurs.   Comorbidity means two chronic diseases or conditions existing simultaneously in a patient.  Chronic migraine is often comorbid with psychiatric conditions such as depression, anxiety, post-traumatic stress disorder, personality disorders and bipolar disorder.However, migraineurs have a reported 2- to 4-fold increase in lifetime risk of developing major depressive disorder. (1)

People who experience migraine earlier in life are more likely to develop depression, and vice versa, over the course of their lifetime.Migraine sufferers who also experience depression should know the signs of both ailments since each might be at a higher risk for the other condition.

WHAT IS DEPRESSION?

According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time:

  • a depressed mood during most of the day, particularly in the morning
  • fatigue or loss of energy almost every day
  • feelings of worthlessness or guilt almost every day
  • impaired concentration, indecisiveness
  • insomnia or hypersomnia (excessive sleeping) almost every day
  • markedly diminished interest or pleasure in almost all activities nearly every day
  • recurring thoughts of death or suicide (not just fearing death)
  • a sense of restlessness — known as psychomotor agitation — or being slowed down – retardation
  • significant weight-loss or gain (a change of more than 5% of body weight in a month)

WHAT IS A MIGRAINE?

Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. (2)

The frequency and intensity of migraines can vary among sufferers but commonly is characterized by

  • a throbbing headache often localized to one side of the head
  • intense head pain usually gradual in onset, then progressively more painful.
  • sometimes accompanied by a pronounced sensitivity to light and sound or nausea and vomiting.
  • a dull, deep and steady pain or throbbing and pulsating if severe
  • can occur any time of the day, through it often starts in the morning.
  • pain in the temples or behind one eye or ear, although any part of the head can be involved.
  • may be accompanied by a variety of sensory warning signs or symptoms, such as flashes of light, blind spots, temporary loss of vision or tingling in your hand or face (MIGRAINE WITH AURA)
  • pain lasting a few hours or up to one or two days,
  • occurrence varies – once or twice a week, or only once or twice a year

Because of the migraine-depression connection, I wanted to bring up a topic I covered in an earlier MigreLief Blog Post – the danger migraineurs face when attempting to treat both depression and migraine headaches at the same time with prescription drugs.

WARNING:  ANTI-DEPRESSANTS AND MIGRAINE DRUGS –
POSSIBLY A LETHAL COMBINATION!

Migraine sufferers should be aware of the dangers of combining some anti-depressants with prescription migraine medications.  Unfortunately, the mechanism of action of many antidepressants is to increase serotonin (a feel good neurotransmitter) levels in the brain. Triptan drugs like Imitrex, which are used to reduce or end the pain of a migraine attack also work by stimulating serotonin receptors.

This combination of antidepressants and triptan migraine drugs, can lead to too much serotonin in the brain. This is not a good thing and can result in a potentially life-threatening condition known as “serotonin syndrome.”

In some people, just the use of triptans drugs such as Imitrex or Zomig alone can result in unhealthy levels of serotonin, leading to serotonin syndrome. This risk increases substantially if these people are also taking an antidepressant like Pristiq or any other of several antidepressants known either as SSRI (selective serotonin reuptake inhibitors) or SNRI (serotonin-noradrenaline reuptake inhibitors).

The symptoms of “Serotonin Syndrome” are:

Rapid heart rate and high blood pressure
Agitation or restlessness
Confusion
Dilated pupils
Loss of muscle control or twitching muscles
Heavy sweating
Diarrhea
Headache
Goose bumps
Shivering

In severe cases of serotonin syndrome life-threatening symptoms can occur:

High Fever
Seizures
Irregular heart beat
Unconsciousness

Sad moods are not among the typical migraine triggers, but some migraineurs notice that they experience sad moods before migraines occur—especially premenstrual migraines. There appears to be increasing evidence that there are a number of links between migraine and depression. As researchers explore these links, findings may eventually lead to insights about the etiology—and potentially even treatment, of the two conditions. People with migraines and comorbid psychiatric or mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.

 

If you and your physician decide to use this combination of drugs, you must be monitored very closely for any of these signs and symptoms of serotonin syndrome.

To the Best of Health

Curt Hendrix, M.S., C.C.N., C.N.S.

 

 

 

 

 

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