Though addiction is rare with short-term use, in the long term it can pose a major problem. After the release of dopamine, the brain creates more receptors for dopamine to enhance the response, and over time this may lead to addiction. Without the opioid, the dopamine receptors are empty, and empty dopamine receptors make us feel bad. The state of addiction is one where the opioid is taken just to feel normal. Without it, people feel they cannot function.
Death from prescription drug abuse — nearly 30,000 per year — is the second leading cause of accidental death in the United States. More people die from prescription drug abuse than from cocaine and heroin combined. The rapid increase has followed the increase in opioid prescriptions.
What can be done for chronic pain? The best approach is to seek a board certified pain specialist who evaluates patients for structural problems and looks more broadly at muscular conditioning, weight and stress. Treatment may involve injections, medications, physical rehabilitation, relaxation strategies for stress and medication for depression. There are limited roles for opioid medication, but based on the extent of abuse and number of deaths, a change is needed from current practice. We need more information to identify when it can be safe and effective.
• • •
Michael Connelly, MD, a board-certified pain specialist with New England Neurological Associates, is on staff at Merrimack Valley Hospital, a Steward family hospital. The Gazette regularly publishes columns by Merrimack Valley Hospital doctors.