First evidence of link between opioid use disorder, chronic pain

Scientists have long noted a link between opioid use disorder and chronic pain, however, the brain mechanism linking opioid use disorder and chronic pain remains poorly understood. The first study of its kind by researchers at The Ohio State University Wexner Medical Center, College of Medicine, and the University of Michigan School of Medicine has uncovered a potential mechanism – central sensitization – among people with opioid use disorder.


Drug. Image credits: RawpixelCC0 . public domain

Central sensitization refers to abnormal pain processing in the brain and spinal cord. People with central sensitization have a spinal cord that is unusually well-functioning at sending pain signals to the brain, and the brain struggles to turn off those signals when they come. This means that people with more central sensitivity tend to have more pain than others.

“Our study is the first to provide patients with the disorder,” said O. Trent Hall, lead author of the study and an addiction specialist in the Ohio State Department of Psychiatry and Behavior. used opioids a scale to measure central sensitization. “Our study provides the first evidence of the underlying central sensitization relationship between chronic pain and the OUD and demonstrates a new tool for easily measuring central sensitization in people with opioid use disorders.”

The results of the study were published in the journal PAIN Reportan official journal of the International Association for the Study of Pain.

The researchers recruited 141 study participants from the Ohio State Wexner Medical Center’s addiction treatment center in Columbus, Ohio. As part of the study, the researchers administered the American College of Rheumatology’s 2011 Fibromyalgia Survey Criteria through an electronic survey. Participants also answered questions about pain interventions, quality of life, and items related to pain beliefs and expectations of pain and addiction treatment.

Chronic pain can lead to an opioid use disorder, and people with chronic pain and this disorder have a harder time quitting opioids than people with just the disorder. So it’s important to find out how pain and opioid use disorder are linked in the brain. The researchers measured quality of life across eight life domains including general health, physical activity, mental health, social functioning, vitality, bodily pain, and role limitations. due to physical health and role limitation due to emotional problems.

According to Hall, they found that more central sensitization was associated with worse quality of life in patients with opioid use disorder.

“Additionally, patients with a higher degree of central sensitization tended to cite pain as a major reason why they first started their opioid addiction, as well as quitting addiction treatment, continuing, and intensifying their addiction. opioid use, and fear of pain causing OUD recurrence. in the future,” said senior author Daniel J. Clauw, MD, Director of the Center for Chronic Fatigue and Pain Research at the University of Michigan.

This study suggests that central sensitization may be an important underlying factor complicating the treatment of chronic pain and OUD. This provides an example for clinicians and other researchers to measure central sensitization in the OUD, which may help them offer better treatments for people with chronic pain and opioid use disorder.

As a physician with a background in both pain and addiction, Hall has cared for many painful patients with both conditions, and he realizes that treatment options are limited.

“It’s important to me to find new ways to help,” Hall said.

“But we cannot create better treatments for chronic pain and opioid use disorders without first understanding the relationship between the two. I did this study because I believe it can provide a new window into what is happening in the brains of patients who need help with pain and addiction. “

Clauw added: “We hope to fund the OSU team within the next year to expand on these findings as we feel that treating opioid use disorder in people with chronic pain will completely different from those without pain.”

The team plans to follow patients with central desensitization and opioid use disorder over time to find out if they respond differently to treatments or have different outcomes. and study whether existing central sensitization treatments are beneficial for patients with chronic pain and opioid use disorder.

Funding is provided by the Community Improvement and Care Innovation Plan (CICIP), a program of the Ohio Department of Medicaid. Clauw has testified in state lawsuits against opioid manufacturers for their role in the opioid overdose crisis. The remaining authors reported no associated conflicts of interest.

Source: University of Michigan Health System

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