In the U.S., one-quarter of all adults suffer from chronic pain. Opioids such as hydrocodone, oxycodone, and morphine can be vital in making acute pain manageable. However, long-term opioid use carries many risks including tolerance, dependence, abuse, addiction, and overdose. There is a growing and legitimate concern in the U.S. about the opioid epidemic. This is driving researchers to find alternative painkillers and ways to make opioids safer. So far in 2018, the new research coming out focuses on creative ways to understand and solve the opioid crisis while continuing to find more effective courses of treatment for pain management with and without opioids. Here’s what you should know.
1. Stopping opioid treatment does not typically make chronic pain worse
Researchers at Washington State University found that discontinuing long-term opioid treatment did not increase chronic pain. In fact, in some circumstances discontinuing opioid use improved pain levels.
The study followed patients suffering from three types of chronic pain: chronic musculoskeletal pain, chronic neuropathic pain, and chronic headaches and migraines. The results showed that no matter the type or severity of the pain, the majority of participants reported the same pain after discontinuing use. For those with mild to moderate pain, their pain improved. In the next year the researchers will continue following the participants with the goal of finding out why some patient’s pain improves.
The research team believes their results are important in the ongoing opioid crisis. They hope clinicians will consider these findings when discussing long-term treatment option with chronic pain patients.
2. Postoperative opioids may make pain worse and last longer
Dr. Linda Watkins, a researcher and professor at Colorado University Boulder, has found evidence that suggests prescribing opiates for acute post-surgical pain may actually prolong pain and make people more reactive to pain.
Researchers conducted their experiments on rats who were given morphine after exploratory abdominal surgery. They found that postoperative pain lasted three weeks longer for the group given morphine than the group given a saline solution. Tapering the rats off of the morphine did not affect the results. This led researchers to conclude that the pain was not a side effect of withdrawal but something else.
The lead researcher believes this phenomenon may be a result of compounding signals in the central nervous system. Specialized immune cells called glial cells are activated during surgery and release proteins that cause inflammation. This process also primes the cells to be “on alert.”
Opiates activate these same cells and, when they are activated again immediately following a surgery, they then respond faster, stronger, and longer. This may result in more inflammation and sometimes tissue damage.
Dr. Watkins believes researching alternative painkillers may be a solution to lingering pain caused from postoperative opiates. She has also begun researching novel proteins and compounds that can be given with opiates to counter the activation of the central nervous system.
3. Medical cannabis legalization lowers opiate prescription rates
A recent study published in the Journal of the American Medical Association examined the way that the legalization of medical cannabis affects opioid use.
Researchers used reports of opioid prescriptions from Medicare Part D plans from 2010 through 2015. They were able to compare prescription rates in states that did not have legal cannabis, states that did, and states that legalized cannabis during the course of their study. They found that in states with legalized medical dispensaries, opioid prescriptions dropped almost 15% and in states with only legalized home cultivation there was a 7% drop in opioid prescriptions.
The research team stresses that there is still a lot of research to be done on medical cannabis for pain management. It suggests, however, that cannabis may be a viable treatment for some types of pain. This study shows that medical cannabis is one of the reasons for the reduced opioid prescription rates in these states. The team believes that because of the opioid epidemic, that fact alone merits further research into cannabis for pain management.
4. Lack of self-awareness among doctors when prescribing opioids
A recent study published in Academic Emergency Medicine wanted to determine how doctors perceive their own prescribing habits.
They asked emergency room doctors at four hospitals to self-report how many opioid prescriptions they wrote compared to their peers. 65% of doctors prescribed more opioids than they thought they did. Opioid prescriptions accounted for roughly 20% of all the prescriptions they wrote. The study also showed that once doctors were shown the reality of their prescribing rates, the number of opioid prescriptions they wrote went down.
The research shows that even with the best intentions, a prescriber’s own self-awareness or lack thereof may be contributing to the opioid epidemic. Additionally, raising their awareness can help them to be more mindful when prescribing.
“We can’t assume providers are behaving optimally and have all the information they need to do what we are asking of them. Most believe they are doing the right thing, but we need to directly address this thinking to be sure they are not part of the problem.”
5. Highlighting gender differences and opioid use
Chronic pain and addiction researchers at Yale University recently published a commentary in The Lancet calling for researchers, clinicians, and policymakers to be more aware of and account for the differences between men and women’s experiences with opioid use.
They emphasize the importance in understanding the challenges unique to women when it comes to opioids. Overall, women generally have greater sensitivities to pain and face social and familial barriers to beginning treatments as they are often primary caregivers.
In addition to these inherent disparities, researchers are also raising concerns over how women are prescribed these drugs. In general, women are more likely to receive an opioid prescription in conjunction with other medications that increase their overdose risk. Women are also three times less likely to receive the life-saving drug naloxone in the event of an overdose. They have also found that most opioid use interventions, which largely have been designed for men, are not as effective for women.
The researchers suggest that more attention should be given in and outside the doctors’ office to address the different experiences men and women have with opioid use.
6. Racial disparities in long-term opioid treatment
A new study from Yale examines racial disparities in chronic pain diagnosis and treatment for racial minorities. Their research findings highlight healthcare disparities for African Americans and Caucasians, especially when it comes to opioids.
To begin, the CDC recommends illicit drug screenings for all patients who use opioids long term. The study, however, showed that these screenings are not taking place regularly for all populations. In fact, African Americans are twice as likely as Caucasians to be screened for illicit drug use despite showing no other signs of drug use.
If a patient tests positive for marijuana or cocaine, 90% of patients continued to receive opioid prescriptions. However, the study shows that African Americans were twice as likely to have their prescriptions discontinued if they screened positive for marijuana and three times as likely to have their prescriptions discontinued if they screened positive for cocaine.
The researchers believe physicians need clearer guidelines for opioid prescriptions and illicit drug use as well as implementing standard practices such as mandatory screening of all patients to account for any individual biases.
7. Calculating U.S. opioid prescription rates by congressional district
Amid the national opioid epidemic, researchers at Harvard recently published a first of its kind study in the American Journal of Public Health by examining the opiate prescription rates based on congressional districts.
Their findings showed that the southeast and rural west had the highest opioid prescription rates. Districts with the highest prescription rates nationwide are in:
- Eastern Arizona
- Northern California
- Rural Oregon
- Rural Washington
Alabama’s Fourth Congressional District had the highest opioid prescription rate with 166 prescriptions per 100 people. Congressional districts located near urban centers such as San Francisco, New York, Boston, and Atlanta tended to have lower opioid prescription rates.
Researchers believe that having district specific data points can help elected officials be more informed and accountable to how the opioid epidemic is affecting their own districts. They hope this data will help representatives advocate more strongly for federal policies to combat the opioid epidemic.
8. Scientists working on non-addictive painkiller
Scientists at Wake Forest School of Medicine have been working to combat the opioid crisis with non-addictive alternative painkillers. Specifically, they are researching a new chemical compound known as AT-121.
Their research has shown that AT-121 is a safe non-addictive painkiller with “morphine-like analgesic effects.” In addition to being a potential alternative to opioids, AT-121 is also effective at blocking abuse potential of prescription opioids, much like buprenorphine does for heroin.
The research team is optimistic that AT-121 could be a valid alternative for people suffering from chronic pain. If results bear out, it could provide the same levels of pain relief without the risk of addiction.
9. Using light to treat chronic neuropathic pain
Scientists in Rome have identified specific nerve cells in the skin that are sensitive to touch and also neuropathic pain in many patients.
Once identified, researchers created a light-sensitive protein that binds to the end of the nerve cell. They then shined a near-infrared light on the cells that caused them to retract from the skin’s surface. This helped some patient’s reduce their pain.
As the researchers explained:
“It’s like eating a strong curry, which burns the nerve endings in your mouth and desensitizes them for some time.”
10. Treating pain with a magnetic gel
Bioengineers out of UCLA are developing a magnetic gel-like substance that could be used to treat chronic muscle pain.
In theory, the gel bypasses pharmaceutical interventions all together. Instead, it physically manipulates the cells on a very small scale. The gel is infused with magnetic particles that are able to actually push or pull certain proteins and ions on the cell membrane.
Researchers noted: “Our results show that through exploiting ‘neural network homeostasis,’ which is the idea of returning a biological system to a stable state, it is possible to lessen the signals of pain through the nervous system.”
Get help if you’re struggling with opioid use
This is just a handful of the new opioid research studies coming out in 2018. Understanding and responding to the opioid epidemic is vital for many communities, families, and individuals across the nation. Just as important is finding effective treatments to improve the quality of life for those suffering from chronic pain.
Simply taking away opioid prescriptions doesn’t resolve the underlying issue of chronic pain and can severely affect a patient’s quality of life.
Because of this, researchers are looking for alternatives that are just as effective without the harsh side effects and risks. They are also gaining a better understanding of the different demographics that are affected by chronic pain and the opioid epidemic. With this information, they can develop new systems and protocols for medical professionals. They can also better understand how and why there is so much variance in opioid use and prescriptions.
The best pain specialists work together with their patients to develop a comprehensive treatment plan. We understand that for millions of people, opioids allow them to lead a life with less pain. However, as medical professionals, we must protect our patients from the risks associated with opioid use.
We work hand-in-hand with our patients to develop a comprehensive treatment plan. We only prescribe opioid medications when other less extreme options have failed and in combination with other therapies. You can read more about PainDoctor.com’s opioid therapy statement and 12-step compliance checklist here.
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