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Chronic Pain and Dependence

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Textbook of Addiction Treatment

Abstract

Chronic or persistent pain is a common problem, affecting around 20% of the population. It can be complex; social, psychological and biological factors are entwined in its causes and effects. The societal factors leading to the increased recognition and demands for treatment of chronic pain have focused on the biomedical aspects and the use of the WHO analgesic ladder, which was intended for treatment of cancer pain. Despite initial optimism, the treatment of chronic non-malignant pain, in the same way as cancer pain, has been found to be ineffective for pain management or improvement in quality of life. Indeed, the opposite effects of increasing disability and dependence seem to be the result, with the epidemic of opioid-related deaths being the tip of the iceberg.

This chapter briefly outlines the underlying mechanisms of pain and dependence, but the main focus is on possible strategies to reduce the potential harms arising from the pharmacological treatment of chronic pain.

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References

  1. Merskey H, Bogduk N. IASP/terminology. [online]. 2019. Available at: https://www.iasp-pain.org/terminology?navItemNumber=576#Pain. Accessed 10 Aug 2019.

  2. Treede R, Reif W, Barke A, et al. Chronic pain as a symptom or a disease the IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19–27.

    Article  Google Scholar 

  3. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:1001–6.

    Article  Google Scholar 

  4. Murray J, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858.

    Article  Google Scholar 

  5. Borrell-Carrió F, Suchman A, Epstein R. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Prac. 2004;2(6):576–82.

    Google Scholar 

  6. Brinjikji W, Luetmer P, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. ANJR Am J Neuroradiol. 2015;36(4):811–6.

    Article  CAS  Google Scholar 

  7. Buchbinder R, van Tulder M, Oberg B, et al. Low back pain; a call to action. Lancet. 2018;391(10137):2384–8.

    Article  Google Scholar 

  8. WHO. Cancer pain relief. Geneva: World Health Organisation; 1986.

    Google Scholar 

  9. Shug S, Palmer G, Scott D, et al. Acute pain; scientific evidence [Online]. 2015. Available at: http://fpm.anzca.edu.au/documents/fpm-apmse4-final-20160426-v1-0.pdf. Accessed 10 Aug 2019.

  10. Berghmans R, Schouten H. Sir Karl Popper, swans and the general practitioner. Br Med J. 2011;343:d5469.

    Article  Google Scholar 

  11. Cook C, George S, Reiman M. Red flag screening for low back pain: nothing to see here; move on. Br J Sports Med. 2018;52:493–6.

    Article  Google Scholar 

  12. van Hecke O, et al. Neuropathic pain in the general population: a systematic review. Pain. 2014;155(4):654–62.

    Article  Google Scholar 

  13. Finnerup N, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599–606.

    Article  CAS  Google Scholar 

  14. Kosek E, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382–6.

    Article  Google Scholar 

  15. Foster N, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83.

    Article  Google Scholar 

  16. Nicholas M, Linton S, Watson P, Main C. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain; a reappraisal. Phys Ther. 2011;91:737–53.

    Article  Google Scholar 

  17. Hill J, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised clinical trial. Lancet. 2011;378:1560–71.

    Article  Google Scholar 

  18. Melzack R. The tragedy of needless pain. Sci Am. 1990;262(2):27–33.

    Article  CAS  Google Scholar 

  19. Porter J, Jick H. Addiction rare in patients treated with narcotics. NEJM. 1980;302(2):123.

    Article  CAS  Google Scholar 

  20. Cousins MJ, Brennan F, Carr D. Pain relief: a universal human right. Pain. 2004;112(1):1–4.

    Article  Google Scholar 

  21. Rummans T, Burton M, Dawson N. How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clin Proc. 2018;93(3):344–50.

    Article  Google Scholar 

  22. OECD. Addressing problematic opioid use in OECE countries. [online]. 2019. Available at: https://read.oecd-ilibrary.org/social-issues-migration-health/addressing-problematic-opioid-use-in-oecd-countries_a18286f0-en. Accessed 11 Aug 2019.

  23. Penington Institute. Australia’s annual overdose report. Carlton: The Penington Institute; 2018.

    Google Scholar 

  24. Portenoy R, Foley K. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25:178–86.

    Article  Google Scholar 

  25. Kalso E, Edwards J, Moore R, McQuay H. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112:372–80.

    Article  CAS  Google Scholar 

  26. Eriksen J, et al. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain. 2006;125(1–2):172–9.

    Article  CAS  Google Scholar 

  27. Chang A, et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department; a randomized controlled trial. JAMA. 2017;318(17):1661–7.

    Article  CAS  Google Scholar 

  28. Ashworth J, Green D, Dunn K, Jordana K. Opioid use among low back pain patients in primary care: is opioid prescription associated with disability at 6-month follow-up? Pain. 2013;154:1038–44.

    Article  CAS  Google Scholar 

  29. Shaw W, Gatchel R, Christian J, Toms Barker L. Improving pain management and support for workers with musculoskeletal disorders: policies to prevent work disability and job loss, Resource compendium for musculoskeletal disorders and pain management, vol. 2. Columbia: IMPAQ International LLC for the US Department of Labor; 2018.

    Google Scholar 

  30. Krebs E, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic Back pain or hip or knee osteoarthritis pain. The SPACE Randomized Clinical Tria. JAMA. 2018;319(9):872–82.

    Article  CAS  Google Scholar 

  31. Pierre J. Abuse of psychiatric medications; not just stimulants and benzodiazepines. Anticholinergic, antipsychotics and gabapentinoids may also be subject to misuse and abuse. Curr Psychiatr Ther. 2019;18(1):11–27.

    Google Scholar 

  32. Brownstein M. A brief history of opiates, opioid peptides, and opioid receptors. Proc Natl Acad Sci USA. 1993;90:5391–3.

    Article  CAS  Google Scholar 

  33. Olson K, et al. Novel molecular strategies and targets for opioid drug discovery for the treatment of chronic pain. Yale J Biol Med. 2017;90(1):97–110.

    CAS  Google Scholar 

  34. Valentino R, Volkow N. Untangling the complexity of opioid receptor function. Neuropsychopharmacology. 2018;43:2514–20.

    Article  Google Scholar 

  35. Porter-Stransky K, Weinshenker D. Arresting the development of addiction: the role of β-Arrestin 2 in drug abuse. J Pharmacol Exp Ther. 2017;361:341–8.

    Article  CAS  Google Scholar 

  36. Chang E, Choi E, Kim KH. Tapentadol: can it kill two birds with one stone without breaking windows? Korean J Pain. 2016;29(3):153–7.

    Article  CAS  Google Scholar 

  37. Yuki Asari Y, et al. Acute tramadol enhances brain activity associated with reward anticipation in the nucleus accumbens. Psychopharmacology. 2018;235:2631–42.

    Article  CAS  Google Scholar 

  38. Elman I, Borsook D. Common brain mechanisms of chronic pain and addiction. Neuron. 2015;89(1):11–36.

    Article  CAS  Google Scholar 

  39. Dowell D, Haegerich T, Chou R. CDC guideline for prescribing opioids for chronic pain — United States. MMWR Recomm Rep. 2016;65:1–49.

    Article  Google Scholar 

  40. Srivastava A, Gold M. Beyond supply: how we must tackle the opioid crisis. Mayo Clin Proc. 2018;93(3):269–72.

    Article  Google Scholar 

  41. Darnall B, et al. International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering. Pain Med. 2019;20(3):429–33.

    Article  Google Scholar 

  42. Control, C. N. C. f. I. P. a. Annual report of drug related risks and outcomes. Atlanta: CDC National Center for Injury Prevention and Control; 2017.

    Google Scholar 

  43. Barbeler D. Australian Pharmacist. [online]. 2018. Available at: https://www.australianpharmacist.com.au/keeping-watch-australian-prescription-monitoring-approaches/. Accessed 28 Aug 2019.

  44. Argoff C, et al. Rational drug monitoring for patients on opioids for chronic pain: consensus recommendations. Pain Med. 2018;19:97–117.

    Article  Google Scholar 

  45. Mueller S, et al. A review of opioid overdose prevention and naloxone prescribing: implications for translating community programming into clinical practice. Subst Abuse. 2015;36(2):240–53.

    Article  Google Scholar 

  46. Sandhu H, et al. What interventions are effective to taper opioids in patients with chronic pain? Br Med J. 2018;362:k2900.

    Google Scholar 

  47. Loeser J, Schatmann M. Chronic pain management in medical education: a disastrous omission. Postgrad Med. 2017;129(3):332–5.

    Article  Google Scholar 

  48. Alford D, et al. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med. 2016;31(5):486–91.

    Article  Google Scholar 

  49. Attal N, Bouhassira D, Baron R. Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol. 2018;17(5):456–66.

    Article  Google Scholar 

  50. Baron R, et al. Peripheral neuropathic pain – a mechanism-related organizing principle based on sensory profiles. Pain. 2017;158(2):261–72.

    Article  Google Scholar 

  51. Bennett M. The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92(1–2):147–57.

    Article  CAS  Google Scholar 

  52. Bouhassira D. Neuropathic pain 4 questions (DN4). [online]. n.d.. Available at: https://eprovide.mapi-trust.org/instruments/neuropathic-pain-4-questions. Accessed 10 Aug 2019.

  53. Chang H-Y, et al. Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study. BMC Med. 2018;16(69):1–11.

    Google Scholar 

  54. Deyo R, et al. Association between initial opioid prescribing patterns and subsequent long-term use among opioid-Naïve patients: a statewide retrospective cohort study. J Gen Intern Med. 2017;32(1):21–7.

    Article  Google Scholar 

  55. Parsons L, Hurd Y. Endocannabinoid signalling in reward and addiction. Nat Rev Neurosci. 2015;16(10):579–94.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. North Queensland Persistent Pain Management Service, Townsville Hospital, Townsville, QLD, Australia

    Stephen Gilbert

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  1. Stephen Gilbert
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Editor information

Editors and Affiliations

  1. Division of Addiction Department of Psychiatry, University of Calgary, Calgary, AB, Canada

    Nady el-Guebaly

  2. Mental Health Department, University of Milano-Bicocca, Monza, Monza e Brianza, Italy

    Giuseppe Carrà

  3. Division of Alcoholism and Drug Abuse Department of Psychiatry, NYU School of Medicine, New York, NY, USA

    Marc Galanter

  4. Population and Behavioural Science Division (Psychiatry and Addictions), University of St Andrews, St.Andrews, UK

    Alexander M. Baldacchino

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Gilbert, S. (2021). Chronic Pain and Dependence. In: el-Guebaly, N., Carrà, G., Galanter, M., Baldacchino, A.M. (eds) Textbook of Addiction Treatment. Springer, Cham. https://doi.org/10.1007/978-3-030-36391-8_87

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  • DOI: https://doi.org/10.1007/978-3-030-36391-8_87

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  • Print ISBN: 978-3-030-36390-1

  • Online ISBN: 978-3-030-36391-8

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