Throughout history, medical professionals have struggled to understand how people experience pain.
The difference between an individual’s perception of pain and a physician’s assessment of that perception have made this a challenging task.
The popular care response has been to provide whatever medication comes close to alleviating the most symptoms. This gives the patient a level of immediate comfort, but it can create long-term problems.
Understanding the History of Opiates
In 2003, Marcia Meldrum, then an associate researcher of psychiatry and biobehavioral sciences at the University of California, provided an overview of pain care applications in an article for the Journal of the American Medical Association. “A Capsule History of Pain Management” detailed how certain substances, while posing a possible addictive threat, also seemed to be the best course of pain treatment to improve a patient’s quality of life. Opiates derived from poppy resin such as opium, laudanum, heroin, and morphine have a storied account of use in the medical community as far back as the 1600s. Even into the late 19th century, many substances were unregulated and didn’t require a prescription.
In the 20th century, pharmaceutical companies manufactured semi-synthetic and synthetic opioids such as oxycodone, OxyContin, hydrocodone, and methadone. In the mid-1990s, certain producers persuaded physicians to prescribe opioids more frequently, assuring that long-term use didn’t present addictive dangers. Twenty years later, as the current opioid epidemic in Georgia reveals, opioid substance abuse is a catastrophic health crisis.
Opiates not only block pain signals, but also mimic the brain’s neurotransmitters—especially dopamine—responsible for producing a euphoric effect. Unfortunately, once brain chemistry is changed by frequent opioid use, hyperalgesia may occur. This condition reduces the medication’s impact and potentially increases pain sensitivity—the very issue medication is supposed to resolve.
The Continued Problem of Opiates for Chronic Pain
Many physicians support the monitored, short-term use of opioids to effectively relieve pain as a result of accident-related injuries, cancer treatment, or post-surgery recovery.
However, the problem still lies with difficulty understanding a patient’s level of chronic pain, isolating the underlying cause, and finding treatment options for the root problem. In addition, if someone claims to be reliant on opiates because of the pain they experience, it’s possible brain chemistry and compulsive behavior are manifesting characteristics of addiction.
Interviewed by the Canadian Medical Association Journal in 2017, Meldrum cautioned that “the problem of how to deal with pain isn’t going anywhere. We have a ‘prescription culture,'” she said. “Too many people see drugs as the answer to not only pain, but to improve their lives. Pain can make it impossible to live your life. So, for many people, if the solution also means they may become somewhat dependent on a drug, they probably think, ‘Well, that would be better than this.'”
What’s more, the Associated Press recently reported that a yearlong study reveals evidence that for people suffering with persistent knee or hip arthritic symptoms or back pain, prescription opioids “worked no better than over-the-counter drugs…and provided slightly less pain relief.” Study lead author Dr. Erin Krebs said, “These results will likely surprise many people, because opioids have a reputation as powerful painkillers.”
Alternatives for Chronic Pain Management
When someone suffers from chronic pain, they’ll do whatever it takes to make it go away. It’s frustrating to consider a variety of options and not be certain of their effectiveness. Yet, there are numerous non-invasive and often drug-free alternatives to pain management and root cause elimination. In 2017, we did a two-part series on potential alternatives, which include:
- Cannabinoid receptor tablets
- Cognitive behavioral therapy
- Hypnotic analgesia
- Myofascial release therapy
- Synthetic capsaicin
- Water therapy
What’s more encouraging is the medical community is also considering alternatives for opioid use in acute care and later during recovery. Referred to as “enhanced recovery,” these innovations include:
- Extending non-addictive painkillers before and during surgical procedures
- Inserting a nerve block—the injection of a nerve-numbing agent—to reduce the spread of pain
- Administering less IV fluids
- Encouraging patients to incorporate gentle movement more quickly after surgery to stimulate vital systems to promote healing
- Suggesting relaxation techniques such breathing exercises, passive muscle relaxation, and meditation