Chronic pain and emotional distress often treated with risky medications

by Sharyn Alden
Chronic pain and emotional distress often treated with risky medications

People suffering from chronic non-cancer pain and severe emotional distress, such as depression, anxiety and substance use, are likely to receive long-term opioid therapy despite a lack of evidence that this treatment helps, reports a new review in General Hospital Psychiatry. The review also noted serious unmet needs for psychiatric care for people with chronic pain.

"Patients with severe emotional issues are likely to receive high-dose, high-risk opioid regimens for over a long period of time," said the review's lead author Catherine Q. Howe, M.D., PhD., assistant professor in psychiatry at the University of Washington School of Medicine in Seattle. But, she added, these tend to do poorly with opioid therapy. Adverse outcomes may include misuse and abuse of opioids and even overdose and death.

Other studies have suggested that mental health disorders are not solely a reaction to chronic pain. They also predispose individuals to the development of chronic pain. There may be common factors such as childhood abuse and neglect that increase the risk of chronic pain, substance use and .

The Institute of Medicine estimates that 100 million Americans suffer from chronic pain. In the past 15 years, use of long-term opioid therapy for chronic non-cancer pain (CNCP) has quadrupled.

Researchers reviewed various studies culled from pain clinics, patient surveys, including phone surveys and health insurance files. They defined frequent opioid use as taking several times a week for one or more months over a calendar year. People with psychiatric disorders were more likely to use prescription opioids.

"What these patients really need is psychiatric care instead of the de facto treatment of opioids," Howe explained. "When psychiatric services aren't available, patients often end up on because the drugs numb the as well as providing temporary relief for ."

Bankole Johnson, DSc., M.D., chairman of the department of psychiatry at the University of Maryland School of Medicine agreed with the study's findings but said the use of opioids was not so much an epidemic as an "overuse of psychotropic drugs."

He added, "It's not clear what the alternatives are for patients when pain is not controlled. The crux is to provide integrative pain care so patients go into remission without the overuse of psychotropic drugs."

Johnson said the study raises the importance of an integrative approach when managing pain care. "The mind and body are closely tied together," he noted. "Doctors sometimes forget that—that pain is an emotional state, which is why people have different pain thresholds."

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mjp
not rated yet Nov 13, 2013
As a care-giver to a chronic pain sufferer (for over 15 years) I have to believe that none of those who say that pain relievers are not in the patient's best interests have lived with someone who is afflicted. Until there is a better treatment, and I pray there will be, pain relievers are the only thing that keeps them alive. When the pain is so intense and so unrelenting that suicide looks appealing (if pain relievers are withheld) it is not mental illness, it is the only way out. Do not advocate withholding pain relievers unless or until there is a cure. To call it mental illness and do so makes the doctor withholding them the Executioner.
There is a catch-all in use by the medical "experts" called "Conversion" It's basically used to put people that cannot be "cured" of their pain by any means into the category of "mental illness". It is a lie that only serves to alleviate the doctor's guilt.
mjp
not rated yet Nov 13, 2013
Further: To tell the difference between someone dependent on medication (like we are dependent on oxygen to live) from an ADDICT, consider the following: an addict will do anything to "get more" including robgery. Someone dependent will just curl up in a ball and try not to breathe (it hurts just to breathe) untill someone comes and helps them.