Millions of people who live with chronic pain use prescription drugs to help them get through the day. For many of them, the only drugs that provide relief are the opioids. This includes morphine, codeine, hydromorphone, oxycodone, methadone and fentanyl. While the opioid drugs can reduce pain in the short-term, new research shows that they might actually make chronic pain worse.
Opioids have the same effect on pain as endorphins, the feel-good chemicals that are released after exercise, sex and acupuncture. Endorphins create very positive changes that promote brain health. They make us happy, relaxed and calm and they lower pain and stress.
Unfortunately, while opioid drugs mimic the pain relief of our natural endorphins, they don’t seem to have the same positive effects on the brain. In fact, a growing body of research suggests that these prescription drugs might actually speed up some of the natural processes that can damage the brain.
This is because of how they affect certain cells in the brain called glia. For decades, scientists assumed that the only brain cells that mattered were neurons. Many other kinds of cells were known, but they were ignored. They were given names like microglia, astrocytes and oligodendrocytes, but no one paid them any attention.
Those days are long-gone. A little over a decade ago, scientists began to realize that while the neurons allow us to see, hear, move and think, the glia are actually responsible for keeping the brain healthy. Changes in glial cells seem to be related to all the major brain diseases, including Alzheimer’s and Parkinson’s dementia, traumatic brain injury, as well as chronic pain. There has been an explosion of research on glia.
These cells are usually hibernating. They only become active when they need to repair damage or clean up toxins. It is normal for them to become activated for a few days by a sprained ankle, but if they remain active for too long they can create problems. They release chemicals called cytokines (IL-1b, TNFa, IL-6 and NO for the scientists) that trigger inflammation. They also ramp up a harmful process called excitotoxicity.
Studies have shown that chronic pain activates the glia in the brain, which is why it is important to treat acute pain. In its natural state, however, our body does an elegant job of keeping this in balance. It eventually releases a natural endorphin, called dynorphin, that turns off the microglia to prevent the brain from overheating. Morphine, the prescription substitute, seems to have the opposite effect. Morphine activates several types of glia, and this can make things worse. This effect has been shown to increase the damage caused by HIV infection of the brain.
What this means is that the average person who uses opioid drugs to control their chronic pain might be doing themselves more harm than good. While these drugs can provide wonderful pain relief in some cases, in others they simply ‘take the edge off’. We do prescribe opioids for patients who benefit from them, but unless we see that they lead to major improvements, we recommend that patients stop using them.
This is typically easier said than done. It can be very difficult to stop these drugs because of withdrawal symptoms. While doctors can help motivated patients wean off them slowly, it can be frustrating and difficult. As specialists in ear acupuncture, we have developed a protocol that allows us to stop these drugs quickly and simply without withdrawal symptoms. It is based on the NADA protocol, which was developed by a neurosurgeon in Hong Kong and is used to treat addiction in clinics around the world.
This new understanding of the important role of glia in maintaining brain health is leading to research in other therapies that might help heal the brain in chronic pain. Melatonin is typically used to promote sleep, but it is very important for brain health because it calms down overactive glia. Low-dose naltrexone, which boosts natural endorphin levels, also helps turn of this overheating of the brain. Meditation, mindfulness and music can have the same effect.
In our experience, the vast majority of patients can discontinue their medication when they are properly supervised and treated with the tools of integrative medicine. This is an important step towards regaining their freedom and ending their dependence on doctors, clinics and pharmacies for their daily survival. Our experience has been that our treatment is less effective in people who use these drugs, and growing evidence seems to show that stopping them is also an important step towards healing.
At Seekers, we use a wide range of tools to help people overcome pain.