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Understanding opioid addiction

Painkillers can be dangerous and addictive


By
May 31, 2016

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Pain, unfortunately, is a part of life. Whether it’s caused by injury or simply the natural process of aging, many people experience pain on a daily basis.

Low back pain, neck pain caused by cervical spine issues, and arthritis-related joint pain are the most common pain-related patient concerns. Other causes for pain can include injury, surgery, depression and even obesity.

Managing pain

Everyday aches and pains are often controlled by popping a couple of over-the-counter pain relievers. But for many people with severe or long-lasting pain, that’s not the answer.

“For a long time, narcotic painkillers were thought to be the best treatment for chronic pain,” says Bryan Schuler, a Park Nicollet pharmacist. “But new research, combined with an incredible rise in painkiller abuse and dependence, has led the medical community to rethink the use of these drugs and focus instead on new methods of pain management.”

A growing danger

Nearly three out of four prescription drug overdoses are caused by painkillers. These overdoses cause more deaths than heroin and cocaine combined. And it’s a growing problem for women, who are more likely than men to have chronic pain and be prescribed prescription painkillers, often at higher doses and for longer time periods.

“Painkillers actually become less effective the more you take them, so we typically only prescribe them for short-term use for acute pain, such as fractures and surgical pain,” says Nadine Maurer, MD, a Park Nicollet Physical Medicine and Rehabilitation doctor. “If the pain continues, it’s important to follow up with your clinician to explore other treatment options.”

How do opioids affect the body and brain?

Painkillers, which are also called opioid pain medications, reduce the feeling of pain by attaching to receptors in the brain, which triggers a release of dopamine, the body’s “feel good hormone.” Our bodies naturally create chemicals in response to pain that can help heal it; these are called endorphins. They decrease pain in the same way as opioid pain medications, but opioids are more potent.

When an opioid is taken, it reduces pain for about four hours; however, pain is amplified for the next 72 hours. As a result, many people have to continually increase the dosage of opioids they take in order to get the same pain relief. This happens because the opioid receptors became less sensitive and larger doses are required to achieve the same level of pain relief.

When someone takes opioid pain medications for longer than two to three weeks, around the clock, the body’s ability to create and use endorphins is destroyed. Endorphins are never released in the body chronically - they are always only released for a short period of time - which allows the body’s pain system to return to normal after the painful sensation is gone. A body that is dependent on opioids is never allowed to return to that normal state.

The body becomes dependent on higher and higher doses of opioid pain medication to feel a reduction in pain, and becomes dependent on opioids to release dopamine normally. This leads to pain and depression when opioid pain medications are reduced or stopped.

Finding a better way

Park Nicollet and HealthPartners are leaders in working to reduce the misuse of prescription painkillers. For many years both have been developing new initiatives and pain management processes – first independently, then together as our organizations combined.

This big shift involved more than simply asking our clinicians to prescribe fewer painkillers; it was about changing our culture and the way we view pain. Instead of focusing on treating the symptom, we’re now more tuned into the causes of pain and how we can help patients alleviate their pain before drugs are needed.

Not only do our pain management experts share their knowledge across the HealthPartners organization, but many give educational presentations to their peers at other health care systems locally and across the country in an effort to shift this national trend of painkiller misuse. Our teams even influenced the state medical licensing board to change its stance on opioids.

We’re proud to be leaders in helping our patients – and the community – find the safest, most effective pain relief.

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