PainRelief.com Interview with:
Mark Sullivan, MD, PhD
Professor, Psychiatry and Behavioral Sciences
Adjunct Professor, Anesthesiology and Pain Medicine, Bioethics and Humanities
Medical Co-Director, UW Telepain
University of Washington
Seattle, WA 98195
PainRelief.com: What is the background for this study? What are the main findings?
Response: This is a review paper than synthesizes neuroscience, pharmacological and epidemiological research on the opioid epidemic. It has been known since at least the 1970s that opioids treat not only pain due to physical damage, but also separation distress.
Functional neuroimaging (fMRI) studies have shown that physical pain (tissue injury) and social pain (social rejection) activate the same limbic brain centers (insula, cingulate cortex). Both chronic pain and depression are associated with dysfunction of the endogenous opioid system in the human brain. Studies of opioid prescribing have shown that patients with chronic pain, who also have anxiety and depressive disorders are more likely to be prescribed long-term opioid therapy at high doses and with concurrent sedatives.
PainRelief.com: What should readers take away from your report?
Response: We have been separating opioid use for the treatment of physical pain from opioid abuse for social pain. But this is a simplistic understanding not consistent with the most current research. Our endogenous opioid system has evolved to regulate both forms of pain to promote our survival. Over the past 35 years, we have tried and failed to target prescription opioids to physical pain through a system of screening and risk stratification called “universal precautions.” This will not work to contain the opioid epidemic.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Research is needed on: strategies to limit opioid refills, the nature and prevalence of complex persistent opioid dependence, and alternatives to the numerical rating scale to assess pain severity and treatment need.
PainRelief.com: Is there anything else you would like to add?
Response: We must rethink the role of pain relief in medical practice. We have a book forthcoming from Oxford University Press on this: The Right to Pain Relief and other deep roots of our opioid epidemic.
When Physical and Social Pain Coexist: Insights Into Opioid Therapy
Mark D. Sullivan and Jane C. Ballantyne
The Annals of Family Medicine December 2020, DOI: https://doi.org/10.1370/afm.2591
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