What is most interesting, however, is the ability to change perception of pain via self-regulation. A 10-week meditation course provided to those with chronic pain proved to significantly decrease the frequency and intensity of the pain experienced, as compared to those with chronic pain who did not undergo the meditation course (Kabat-Zinn, Lipworth & Burney 1982).
The discovery of self-regulation is a revolutionary tool for solving the opiod-addiction crisis. Part of the problem is that pain is both subjective and objective, and as of now, treatment of "subjective pain" is lacking. As physicians, it is unethical to dismiss a patient's complaints of pain without offering treatment, however, many patients abuse pain medications. The doctor must differentiate between what pain or how much pain is caused by physical injury to tissue, and how much of that pain is psychologically enhanced. This, of course, is not an exact science, and even the most experienced diagnosticians can make a mistake; even the best self-regulation on pain cannot completely conquer pain if it is physically induced (Wager, Atlas, Lindquist, Roy, Woo, 2013), leading to unintended patient suffering. This dilemma becomes increasingly complicated in cases of known prior opiod addiction and deciding when it is appropriate to deny pain medication when the patient complains of unbearable pain. Hopefully, with more research on self-regulation techniques, the use of opiod based pain medications can be reduced.
Works Cited
Kabat-Zinn, J., Lipworth, L. & Burney, R. J Behav Med (1985) 8: 163. https://doi.org/10.1007/BF00845519
Solberg Nes, L., Roach, A.R. & Segerstrom, S.C. ann. behav. med. (2009) 37: 173. https://doi.org/10.1007/s12160-009-9096-5
Wager, T., Atlas, L., Lindquist, M., Roy, M., Woo, C., et al. “An FMRI-Based Neurologic Signature of Physical Pain — NEJM.” New England Journal of Medicine, 11 Apr. 2013, www.nejm.org/doi/full/10.1056/NEJMoa1204471.
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ReplyDeleteIrene,
ReplyDeleteI agree that in this day in age there is an opioid-addiction epidemic taking over the United States. The National Institute of Drug Abuse reported that there was 64,000 deaths related to opioid in 2016 (Rudd et al., 2016). It is exciting that there are steps being taken to better understand pain and attempting to find new treatments. Pain is both subjective and objective, like you said, and that makes it extremely hard for physicians to diagnose and treat it. It will be interesting how the treatment protocol for pain will hopefully change over the next few years.
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65. doi:10.15585/mmwr.mm655051e1.
While I agree that our country is currently in an opioid epidemic, I don’t think that reducing the number of opioid prescriptions will solve the entire problem. Preventative medicine is always a good thing, and the pain protocol for doctors should be reviewed and edited. However, I believe that to help reduce this opioid addiction crisis, we need to start helping those already affected by addiction as well. I found an interesting article about a withdrawal symptom reducing drug (1) for those suffering from opioid addiction. Although the drug itself, buprenorphine, was approved 15 years ago, it has recently been improved in the form of an injection once a month in a health care setting. While drugs like buprenorphine could be considered a critical component in reducing opioid addiction, the FDA always reminds the public that they are not a sole source of treatment. Like you mentioned, in order to confront addiction in a healthy and long-lasting manner, behavioral counseling or self-regulation is necessary for a “whole patient” approach (2). I think that with all three of these tactics combined (reduced prescription, symptom reducing medication, and therapy) we could possibly start getting a handle on reducing the opioid epidemic in America.
ReplyDelete(1) http://www.newsweek.com/fda-approves-injectable-opioid-help-fight-americas-drug-crisis-729184
(2) https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
There have been multiple studies that have linked mindfulness with an increase pain tolerance as well as a faster recovery rate. Mindfulness, which is a type of meditation that specifically focuses on being in the present moment. Its originates from ancient Buddhist practices, but has now integrated itself into treatments in the Western culture. Here is a great link to a doctor who created a program that uses mindfulness to counteract stress at the University of Massachusetts Medical School ( https://greatergood.berkeley.edu/mindfulness/definition ). Mindfulness has been linked to increasing the body's immune system (Davidson), as well as increasing the amount of gray matter in our brain (which is related to emotions, and memory), in addition to many other benefits (Goodkind). Maybe if doctors prescribed more of this type of meditation instead of opioids, we would not have such a crisis on our hands.
ReplyDeleteDavidson: https://www.ncbi.nlm.nih.gov/pubmed/12883106
Goodkind: https://greatergood.berkeley.edu/article/item/can_meditation_make_your_brain_stronger/