Addiction to chronic pain: towards a pain free brain

Adults who have more than two health problems are likely to receive a prescription for a painkiller at least once every six months.

Chronic pain is one of those heart sink problems of medicine. Nothing chronic is ever simple or curable. Originally it was thought that pain became chronic when the circumstances that initiated it were not resolved. We now understand that chronic pain is much more than a signal of transition from the curable to the incurable.

The addiction to pain develops long before the addiction to pain killers.

 

There are lots of culprits beyond the initiating condition that contribute to chronic pain. As with all our health problems, there is a genetic component. So far, over 500 genes have been implicated in chronic pain.

There is even a library of pain genes in Canada. The likelihood of inheriting one of these genes and becoming more susceptible to chronic pain is about 29%. For chronic pain sufferers and their families, it is well worth a visit to this library.

Chronic pain can be an environmental health hazard. Being around a parent or significant adult who is suffering from chronic pain can also increase the risk. Parental and adolescent chronic pain often go together.

Chronic pain may not be infectious but the role modelling of pain certainly is.

Then there is the addiction to pain that develops – long before the addiction to pain killers. This doesn’t just happen to people with sadomasochistic tendencies. Over 77% of chronic pain sufferers overstate the pain they remember. How much they exaggerate depends on their recall of the worst pain they ever experienced, and their most recent mood.

We often attribute this embellishment to manipulative help-seeking or victim behaviour. However, deep in the hippocampus, a part of the brain that works unconsciously to regulate our bodily functions, there is a system for reinforcing chronic pain.

Increased pain traffic along the highway in the hippocampus can feed a feedback loop that is hard to shift.

If the addiction in chronic pain is to pain itself, legislating restricted use of painkillers, educating prescribers on more rational prescribing and blaming pharmaceutical companies for increasing chronic pain sufferers’ addiction to painkillers are far too late as strategies.

More research needs to be done on how the genetic and environmental influences precipitate chronic pain. For example, what strategies can be used, not just to prevent the development of chronic pain, but to return the signals to the brain to a pain free state.

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