Chronic Pain and Trauma

Understanding the opioid epidemic in America.

Posted Sep 28, 2018

I recently gave a presentation at the Michigan Brain Injury Fall Conference on understanding chronic pain from the mind-body perspective.  With the rise of public awareness of the opioid epidemic in the United States—which is now the number one cause of accidental death, with over seventy thousand deaths from accidental overdoses of prescription drugs last year—discussion about the mind-body perspective on pain has become a more attractive public discussion. 

The role of psychology in the treatment of pain became center stage with psychologist Ronald Melzack’s conceptual model of pain, which he termed the Gate-Control Theory, first introduced in 1965 (Melzack and Wall, 1965).  According to the ground-breaking theory, the spinal cord contains a metaphorical neurological gate that opens and closes enabling or disenabling pain signals to pass to the brain.  Melzack went on to direct one of the first university-based pain clinics in Canada.

Medicine’s Fumble

In his 2015 award-winning book Dreamland: The True Tale of America’s Opiate Epidemic, Sam Quinones tells the incredible story of how in 1980, one letter to the editor published in New England Journal of Medicine unleased a frenzy of opiate prescribing to which the current opiate epidemic is attributed.  According to Quinones, a medical researcher known as Hershel Jick at Boston School of Medicine researched his hospital database to probe the question of how addictive opiates were when prescribed to hospitalized patients.  His data showed addiction was rare.  Dr. Jick sent a one-paragraph letter to the editor of NEJM, and it was published under the title “Addiction Rare in Patients Treated with Narcotics.”  According to Quinones, this one paragraph letter went on to be cited by other medical researchers as a definitive study that opiates were safe for all patients with little risk of addiction.  Dreamland is a book all professionals in the healthcare industry need to read.  A fascinating Senate hearing exploring causes and solutions of the opiate epidemic with Mr. Quinones is well worth watching and is available on YouTube.  It is well established that many non-biomedical approaches to chronic pain are as—if not more—effective in helping patients manage their pain.  An excellent resource is Dr. Howard Schubiner's Unlearn Your Pain, which offers a review of alternative treatments and perspectives on pain.

References

Melzack, R. and Wall, P.D. (1965).  Pain Mechanisms: A New Theory.  Science, vol. 150, p 971.

Quinones, Sam (2015).  Dreamland.  The True Tale of America’ Opiate Epidemic. 

Schubiner, Howard (2016).  Unlearn Your Pain.  A 28-Day Process to Reprogram Your Brain.