New Studies Confirm – and Contradict –
Conventional Wisdom on Chronic Pain
by Ian McLoone
- Chronic
pain patients have long been told it’s all in their heads. Well, a team at
McGill University just submitted
more
proof. The researchers, led by Prof. Laura
Stone, found that injuries resulting in chronic pain are associated with
epigenetic changes in the
brains of mice which can be observed 6 months after the date of injury. These
heritable changes, called DNA methylation, have far-reaching consequences
across the entire genome and can impact behavior and well-being – but were also
shown to be reversible. “
The implications of epigenetic involvement in chronic
pain are wide reaching and may alter the way we think about pain diagnosis,
research and treatment,” the authors say. Future considerations for treatment
will likely include behavioral and pharmacological interventions that focus on
reversing DNA methylation in brain.
-
Think all addicts make risky chronic pain patients? Think again. For decades,
the conventional wisdom has told us that addicts and alcoholics are
constitutionally incapable of managing chronic pain with the help of opioid
pain relievers – no matter what their drug of choice had been. However, a recent
study suggests that this isn’t necessarily the case, and that risk factors for
opioid misuse are dynamic and complex.
The
study, published this January in the Drug and Alcohol Dependence journal, found
that the trait most significantly associated with risk for prescription opioid
misuse was “pain catastrophizing” and that, “current substance use disorder
[SUD] status was not a significant predictor [of risk].” While it’s been shown
elsewhere
that simply being prescribed opioids constitutes a significant risk factor for
abuse and misuse behaviors, this study seems to suggest that by screening for
past or current SUD, we may be missing the point.
Dr.
Carlton Erickson, PhD, director of the Addiction Science Research and Education
Center, tells me it’s an issue that’s “currently being hugely debated across
the nation…mainly [by] pain medicine physicians and addiction medicine
physicians.” Much like Dr Willenbring, he stresses the importance of an
integrated and comprehensive approach to working with such patients and
suggests ensuring access to, “a
team consisting of an addiction medicine specialist,
pain management specialist [and] counselor…who can guide the treatment while minimizing
the likelihood of” misuse. On a related note, there was news last year that chronic pain patients
on opioid therapy can be successfully converted to buprenorphine. Specifically,
patients on a morphine equivalent dose of 100-199 mgs seemed to fare better
than those on higher doses.
- Does the color of your
skin affect your chronic pain treatment? A new study suggests it does. Leslie R
Hausmann, PhD, led a team of researchers from the VA Pittsburgh Healthcare
System to investigate whether racial disparities existed in the follow-up and
monitoring of patients who were prescribed opioid medications over a two-year
period. In adjusted comparisons, they found black patients were less likely to
have their pain documented than white patients, less likely to be referred to
pain specialists, and more likely to be referred to a substance abuse
assessment. Also, among those patients who had at least one drug test, black
patients were subjected to more drug testing than their white counterparts. Among
the report’s conclusions, the authors suggest that, “Addressing disparities in
opioid monitoring and follow-up treatment practices may be a previously
neglected route to reducing racial disparities in pain management.”
Ian McLoone is a graduate
student at the University of Minnesota’s Integrated Behavioral Health program,
a Graduate Research Assistant at the Minnesota Center for Mental Health, as
well as a clinical intern at Alltyr, Inc.
