Information on chronic pain and addicton

Christopher Frandrup, M.D., DABPM, FIPP

Category: Research

Is Pain Hereditary?

Is Pain Hereditary? | Allpria.com

Is Pain Hereditary?

Chronic pain is a complex medical condition with no easy answers. While acute pain can often be traced to one particular injury or illness, why acute pain turns into chronic pain long after the accident occurs remains a mystery. This mystery is the focus of a new study that attempted to answer the question: is pain hereditary?

Is pain hereditary?

A report in the journal PAIN®, the official publication of the International Association for the Study of Pain (IASP) published by Wolters Kluwer, looked at this question in-depth. Researchers visited with families to investigate the role genetics might play in chronic pain. Amanda L. Stone of Vanderbilt University and Anna C. Wilson of Oregon Health & Science University developed a framework of chronic pain transmission, writing:

“Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family-centered and include at-risk children.”

To be clear, this report does not indicate a clear genetic marker for pain. The report looks at not only genetic evidence but also environmental factors. This framework includes five specific ways in which chronic pain risk might be passed from parent to child.

Is pain hereditary?

Researchers believe that nearly half of the risk of chronic pain can be genetically linked.

Is pain biological?

The report found that neurobiological development in children could be affected by a parent’s chronic pain, especially in early, formative years.

Is pain social?

Children with a parent in chronic pain may be more prone to “maladaptive” behaviors such as negative thinking and catastrophizing (exaggerated response to or worries about pain).

Is pain practical?

How parents in pain interact with their children seems to play a role in chronic pain transmission. Parents in pain may not be as active or display as much warmth towards their children. They may also be more permissive or inconsistent in their rules and parenting due to pain level fluctuations.

Is pain environmental?

Simply living in an environment where pain is a daily event can be stressful. Add in the high cost of chronic pain and a parent’s inability to contribute to the household. Children may be affected by this stress for years, well into adulthood.

Researchers Stone and Wilson created this framework to help understand the complex ways in which chronic pain is passed down from parent to child. Their work does not quite answer the question “Is pain hereditary?” They looked to see more if pain was prevalent across generations in families and to figure out what factors influenced that.

Genetics and disc degeneration study

Other studies have specifically looked for a genetic link in pain across generations. A study out of King’s College London found a specific gene that is connected to degeneration of discs in the lower back. This degeneration is connected to an increased risk of age-related lower back pain.

Dr. Frances Williams, senior lecturer from the department of twin research and genetic epidemiology at King’s College London, summed up the genetic link, noting:

“We have performed, using data collected from around the world, the biggest genome-wide association analysis of lumbar disc degeneration (LDD). We know that people whose discs wear out are at increased risk of episodes of lower back pain, but normal human discs are hard to get hold of to study so until now our knowledge of normal human biology was incomplete. We have identified a gene called PARK2 as associated with LDD. We have shown that the gene may be switched off in people with the condition.”

Research on pain perception in families

Other research into the hereditary link to pain found that genetics may play a role in the perception of pain itself. Tobore Onojjighofia, MD, MPH, with Proove Biosciences and a member of the American Academy of Neurology, looked at over 2,700 people with chronic pain. All of these patients were taking opioids for pain.

He asked participants to rate their pain as follows on a scale from one to ten:

  • Low: One, two, or three
  • Moderate: Four, five, or six
  • High: Seven, eight, nine, or ten

Patients who rated their pain as zero were not included in the findings.

Of the study participants, 9% had low pain perception, 46% had moderate pain perception, and 45% had high pain perception.

Researchers compared the ratings to the presence of certain genes.  They looked for variations in the DRD1, COMT, OPRK, and DRD2 genes. Their findings indicated certain commonalities in gene variants, including:

  • Low pain perception: The DRD1 gene variant was 33% more prevalent in the low pain group compared to the high pain group
  • Moderate pain perception: COMT and OPRK variants were 25% and 19% more prevalent than in those with a high pain perception
  • High pain perception: DRD2 variant was 25% more common than in those with moderate pain

These results indicate that even if pain itself is not hereditary, pain perception may be. The findings of this study confirm earlier research done by King’s College London. This study showed that those with increased pain sensitivity had less variation in their genes than people who were less sensitive to pain.

What the research means for patients

Studying genetic links to pain can lead to more targeted and individualized treatments tailored to an individual’s DNA. Ruth McKernan, chief scientific officer of Pfizer’s research unit noted that research findings on genetic links to chronic pain can result in tremendous progress for effective pain medication, saying:

“This study demonstrates the value of collaborative efforts between academia and industry. The genetic influence on normal pain processing in human volunteer populations will add to other approaches and help us prioritise potential new mechanisms for treating pain.”

Has your family experienced intergenerational chronic pain? And what do you think: Is pain hereditary?

Sorry, opioids probably aren’t helping your back pain

7619349538_25d476aa12_o

It’s time to really talk about opioid use. Chronic pain is no laughing matter, and it’s nothing to be flippant about. We see thousands of patients a year who suffer terribly from lower back pain and other conditions. The struggles that they face in their daily lives, and the challenges that their chronic pain presents to their friends and family, are very real. We take them very seriously. We live our mission of helping patients get their lives back every day, and we want them to know that we consider them like our own family. And as with our own family, it’s time for some tough talk: opioids are probably not helping your lower back pain. In fact, opioids may be making your lower back pain worse.

Research on opioids for lower back pain comes up short

For years now researchers have been looking deeply into opioids for chronic pain of all types. They have amassed hundreds of studies over decades looking at opioids for both short- and long-term use.

Again and again, the evidence shows that opioids have limited effectiveness in treating lower back pain. The most recent findings come just weeks before this post. In a meta-analysis of 20 trials looking at the safety and side effects of opioids for lower back pain with no clear identifiable cause, researchers found that opioids had about half the effectiveness for pain relief as that of an inactive placebo. In addition, many of the study participants were unable to handle the side effects of opioids, with over 50% experiencing side effects so severe that they withdrew from the studies.

So why are doctors and patients alike still working under the assumption that opioids are effective?

A brief history of opioids and lower back pain

Opioids have been around in some form since 3400 BCE (in the form of poppies). Fast forward thousands of years to the 1990s when undertreatment of pain became a rallying cry for more aggressive interventions and pain management.

One of these interventions was the development of extended release opioids, including morphine, oxycodone, and fentanyl. Pain lobbyists pushed for wide release and prescription of opioids for all types of pain beyond non-cancer pain, which has generally always been the standard of care.

These slow-release medications produced in pain patients an overwhelming feeling of euphoria and a perception of pain relief. It stands to reason that a person suffering for years from chronic pain would embrace this feeling, but there was one huge caveat: the body’s adaptability to this type of medication.

Doctors began prescribing these miracle drugs to excess, with patients understandably clamoring for relief.

We want to note again that we truly understand why patients and their doctors adopted opioid prescription practices so readily. To see patients who had been suffering for decades report pain-free days and a restored hope for the future is what every doctor hopes for.

But in the ten-year period from 1998 to 2008, opioid prescriptions doubled. Along with that prescription doubling came over 730,000 visits to the emergency room due to misuse or abuse of prescription opioids, doubling in just five years. In 2002, over six million people in the U.S. were abusing prescription drugs.

The changing face of addiction

The vast majority of those with opioid dependence are not who you might think they are. Many people who begin taking opioids for acute pain find themselves physically dependent on them in a short time. In fact, many patients leave the hospital physically dependent on opioids after an operation, suffering minor withdrawal symptoms that they may believe is a cold or a virus contracted at the hospital.

It should be noted that physical dependence is not the same as addiction. Physical dependence on opioids is the same as physical dependence on insulin for Type 1 diabetics. The body becomes used to functioning in a certain way with their medications and struggles to acclimate after those medications are withdrawn. Addiction is characterized as a behavioral component that usually accompanies a physical dependence.

That being said, it is remarkably easy to become dependent on opioids, and the longer you take them, the more likely you are to develop both physical dependence and an increased tolerance to their effects. Patients may find that previous prescriptions may no longer help with their pain, and they may begin to suffer withdrawal symptoms such as nausea, fatigue, muscle pain and weakness, and irritability or anger.

The person who finds themselves “addicted” to opioids may still be able to function in daily life, but the longer they take opioids, the more dangerous they become. Long-term use is associated with disruption to the menstrual cycle, a weakened immune system, and affected sex hormones. Additionally, side effects may include nausea, constipation, and difficulty concentrating, problems which worsen as time goes on.

Roger Chou, M.D., associate professor of medicine at Oregon Health and Science University in Portland points out that new research has utterly debunked opioids’ effectiveness against lower back pain, noting:

“The old perception about opioids is that they are reasonably effective and safe for chronic pain, but what we’ve come to realize is for many types of pain they don’t work all that well and are actually associated with significant harm.”
Gary Franklin, M.D., research professor of environmental and occupational health sciences at University of Washington in Seattle believes that the evidence has become overwhelming against prescribing opioids for chronic pain:

“What concerns me is that there is no clear evidence that people who take opioids over the long term can do more or get around more easily. But we do know that the higher the dose of the drug and the longer you take it, the greater your risk.”
Opioids – what are they good for?

In specific, controlled instances, opioids work well for pain management. End-stage cancer pain and pain as a result of surgery or in the acute, short-term stage of an injury are two times when opioids are recommended and are the standard of care.

But for chronic lower back pain? There is no evidence that the benefits from opioids outweigh the risks. Indeed, it does not seem that opioids have any more affect on chronic lower back pain than a placebo.

Opioids and chronic lower back pain – the bottom line

The bottom line for opioids and chronic lower back pain is this: there is no evidence that opioids are effective in treating chronic lower back pain, and the risk of side effects, dependence, and death increase the longer a patient takes them.

If you are currently taking opioids for chronic lower back pain, it’s time to talk to your doctor about other options. It is never too late to make changes in your health, and a conversation with your pain management specialist is a great place to start.

Powered by WordPress & Theme by Anders Norén