Chronic pain involves more than just hurting. People suffering from pain often experience sadness, depression, and lethargy.
These days, I’m almost surprised they’re not claiming that people are causing their own pain when they experience “sadness, depression, and lethargy”.
That’s one reason opioids can be so addictive — they not only dampen the pain but also make people feel euphoric. [not!]
Wrong. Those of us using opioids for serious pain do not experience this euphoria; see Opioids + Pain != Euphoria for an explanation why this doesn’t happen.
Researchers at Washington University School of Medicine in St. Louis have shown they can block receptors in the brain responsible for the emotional components of pain and restore the animal’s motivation.
That’s what I really want and need: a medication to restore all the motivation I lose from facing pain that arises from so many activities.
Their findings could lay the groundwork for developing new, less addictive approaches to pain treatment.
Why not provide this medicine to people with anxiety and depression too?
Since it’s fashionable to assume that some emotional discomfort is at the root of our chronic pain, such a drug would free a patient who is catastrophizing, wouldn’t it?
“By targeting the emotional aspects of pain, we hope to make pain less debilitating so that patients won’t crave the emotional high they get from opioids.”
I’m insulted by this common erroneous assumption that we crave the “emotional high” from our pain medication. Getting pain relief is always a pleasure in itself, but far from the euphoria we see described by addicted people.
All these pain researchers really need to experience some of their own pain and then relief from opioids before assuming they know why we “crave” our opioids.
Opioid painkillers, such as morphine, oxycodone and fentanyl, target receptors on brain cells called mu opioid receptors. In contrast, the Washington University researchers studied kappa opioid receptors, which operate very differently.
Activating the kappa receptor makes people feel depressed, sad and unmotivated.
Some of the rats in the study had been injected in a paw with a substance that causes persistent inflammation. To measure the emotional effects of that pain, the researchers used a rewarding task in which the animals could work for sugar as a way to measure motivation. After being taught to push a lever to get sugar, most rats will keep pushing. In these experiments, the animals had to push the lever progressively more each time they wanted a pellet of sucrose.
When the animals experienced pain, they were less motivated to work to obtain the reward,” said first author Nicolas Massaly, PhD, an instructor in anesthesiology.
“It’s often the same for people in pain who don’t get as much pleasure from daily activities they usually enjoy.”
That’s certainly an odd way to state it.
People in pain not only don’t enjoy their regular activities, but they also don’t enjoy *any* activity (and even life itself) because we are in pain. What is it about real-life pain that these researchers cannot understand?
Everybody knows how unpleasant pain is just by itself. Yet, these researchers seem to think it is only unpleasant because it has referred effects like side effects.
They completely ignore the main effect of bodily pain which has evolved to create the most extreme unpleasant “sensation” an organism can experience, so extreme that an organism will exhaust every last bit of its energy to escape it, which is exactly why torture is so effective.
But when the rats with inflamed paws were treated with a compound to block kappa opioid receptors in their brains, the animals recovered the motivation to obtain the sugar, and pushed the lever as often as those who did not have inflamed paws.
They were able to demonstrate that when rats were in pain, their kappa opioid receptors were very active in a part of the brain — the nucleus accumbens — linked to emotion.
The researchers dampened this kappa opioid receptor activity by blocking the release of a natural stimulator of kappa opioid receptors called dynorphin — which is produced in the brain and is kind of like the inverse of the endorphins released by activities such as exercise.
The researchers don’t seem to understand that when we have chronic pain we still push ourselves to exercise, but it’s far more painful than lying still.
For chronic pain patients exercise does not make them feel better; it makes them feel worse. This is what makes it so hard to follow an exercise program in order to get the long-term benefits of exercise: the immediate result is just more pain.
“By blocking dynorphin release, we were able to restore motivation in the animals despite the fact that we did not completely eliminate their pain,” Massaly said.
I would be very curious to try a drug like this, one that blunted my emotional response to pain without affecting the physical response of my body. This would be like passing a kidney stone while just going about your daily business and ignoring it.
I really cannot imagine what that would be like. The scenario would go like this: you stub your toe and it hurts terribly as usual but you don’t care, so you might kick that stone over and over and over again because there is no emotional component of being attracted to or repulsed by the pain that you suffer. Really?