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The Prince of Pain Killers

Written by Adam - Neuroscience at Zenytime

The Prince of Pain Killers

While the circumstances around Prince’s death remain unresolved, they appear to point to his grave attempts to manage chronic pain.  Prince’s legend goes beyond his music and persona to his health fanaticism, whether it was his aversion to any form of recreational drug use or insistence on eating clean and raw foods.  That even the most hardworking, disciplined, health fanatical of us can fall prey to the dangers of opiate abuse is indeed a sign of the times.  While fatal overdoses have dominated the public discussion about the use of opiates for pain, there are other significant health consequences that can follow from the powerful psychological dependency they can cause.

Of the 164 million pain-related visits to doctors in 2010, about half of patients were treated with some kind of pain reliever. 20 percent were treated with an opioid. While the long term use of opioids may help to successfully regulate chronic pain, the number of individuals that may start abusing the drugs or develop other serious side effects does not trail far behind.   

The effective management of pain is twofold: a reduction in pain and an improvement in physical function. By reducing pain, we expect to help individuals become physically active more quickly. The hope for the effectiveness of opioids was driven by the belief that by reducing pain these drugs would promote improved physical function.   However, a 2008 study by the California Workers Compensation Institute found that higher doses of opioid painkillers kept workers out 3x longer than those with similar injuries without such treatments.  In attempt to manage pain, high opioid doses may do the opposite as intended, further limiting the regaining of physical function.

For many reasons, including over-reliance on opioids, and how research has consistently shown great individual variability in response to analgesics, i.e., painkillers, there is a large movement toward a multimodal approach to treating pain. These multidisciplinary approaches can combine a variety of medications as well as nonpharmacological measures. Major studies involving the a multimodal approach, such as those by the Mayo Clinic http://1.usa.gov/12bWYX3, found that patients who underwent such programs, that involve replacing medications with alternative approaches such as mindfulness mediation, can make significant progress, critically both in reduced pain and increased physical function, even when weaned off opioids.

Pain management is more than the removal of the experience of pain. Untreated pain is itself damaging to our bodies and brains. The stress response to pain results in activating the fight-or-flight sympathetic nervous system. Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems. The cardiovascular system responds to stress of pain by activating a variety of undesirable effects, including increased heart rate, blood pressure, cardiac work, and oxygen demand. Continuous, unrelieved pain may create a sense of helplessness and hopelessness, which can result in anxiety and chronic depression.

The stress pain response is not only damaging; it also increases the experience of pain. One antidote is to activate the parasympathetic nervous system and its dedicated vagal nerve. Both acute and chronic pain are associated with reduced vagally mediated heart rate variability (vmHRV), an indication of decreased vagal activity and parasympathetic withdrawal, a risk factor for chronic heart disease.

While direct stimulation of the vagal nerve decreases pain, it has also been shown that an individual can control their pain through slow controlled breathing. While pain is associated with fast shallow breathing, engaging the opposite through .1 Hz breathing is an anti-stress response that increases parasympathetic activity and vmHRV. Researchers administering painful heat pulses found participants' ratings of pain intensity and unpleasantness are reduced during slow paced breathing. In addition to lessening acute pain, slow controlled breathing can help chronic pain sufferers, with the benefits extending to Fibromyalgia patients.

.1 Hz breathing is an important element of any multi-modal approach to pain management. .1 Hz breathing helps strengthen an anti-stress response, to fight the damaging physiological effects of stress associated with acute and chronic pain. It places front and center the importance of stress management in treating pain. It also places the individual more in control of managing their pain, potentially reducing drug dependence, and increasing independence.

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