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Opioid overuse pain syndrome (OOPS): The story of opioids, Prometheus unbound

Anand W. Mehendale, MD, Mark P. Goldman, PhD, Rachel P. Mehendale, BA

Abstract


Throughout history, opioids have effectively alleviated pain but not without the risk of addiction and death. Seductive and dangerous, full of promise and destruction, opioids are both revered and feared by Western culture. Their exponential use in “developed countries” is now an enormous public health problem and requires us to harness their properties with scientific rigor and adequate safeguards. The use of opioids for the treatment of chronic nonterminal pain (CNTP) has been a relatively new phenomenon which has coincided with the proclamation by the Joint Commission on Accreditation of Health Care Organization in 2000 that pain assessment be the “fifth vital sign,” notwithstanding the fact that pain is a symptom and not a sign.1 Nonetheless, this resulted in a culture of a marked increase in use of opioids for acute and chronic pain management. Consequently, there are many unintended outcomes which include opioid-induced hyperalgesia increased diversion, addiction, and death. Understandably, this has resulted in many regulatory responses from such agencies such as the Drug Enforcement Administration (DEA) and state medical boards. This article proposes a clinically relevant paradigm of opioid overuse pain syndrome. The goal of this article is to inform the clinicians of the complicated neurobiology of opioids. It is our hope that scientists rather than government regulators dictate the appropriate response to the epidemic of over prescription of opioids. A similar designation of “medication overuse headache” has resulted in near extinction of excessive use of opioids in the field of headache medicine.


Keywords


chronic pain, opioids, opiates, pain

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References


Lanser P: Pain management: The fifth vital sign. Healthc Benchmarks. 2001; 8(6): 68-70, 62.

Klinke A, Renn O: Prometheus Unbound Challenges of Risk Evaluation, Risk Classification, and Risk Management (working paper). Stuggart, Germany: Akademie fur Technikfolgenabsehatzung in Baden-Wurttemberg, 1999.

Harrison Narcotics Tax Act, 1914. Available at www.naabt.org/documents/HARRISON_NARCOTICS_TAX_ACT_1914.pdf. Accessed December 6, 2012.

Lee LE: Medications in the control of pain in terminal cancer, with reference to the study of newer synthetic analgesics. JAMA. 1941; 116(3): 217.

Porter J, Jick H: Addiction rare in patients treated with narcotics. N Engl J Med. 1980; 302(2): 123.

Merskey H, Loeser JD, Dubner R: The Paths of Pain. 1975-2005. Seattle, WA: IASP Press, 2005.

Meier B: In guilty plea, OxyContin maker to pay $600 Million. New York Times. May 10, 2007. Available at http://www.nytimes.com/2007/05/10/business/11drug-web.html?pagewanted=all. Accessed November 29, 2012.

Sabet K: How to treat the epidemic. New York Times. February 15, 2012. Available at http://www.nytimes.com/roomfordebate/2012/02/15/how-to-curb-prescription-drug-abuse/how-to-treat-the-prescription-drug-epidemic. Accessed December 12, 2012.

Simon-Wastilla L: National Monitoring program. New York Times. February 16, 2012. Available at http://www.nytimes.com/roomfordebate/2012/02/15/how-to-%20%20curb-prescriptiondrug-abuse/we-need-a-national-prescription-drug-monitoringprogram. Accessed January 20, 2013.

Meier B: Tightening the lid on pain prescriptions. New York Times. April 8, 2012. Available at http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-dangerwithout-oversight.html?pagewanted=all&_r=0. Accessed December 12, 2012.

FDA: Risk management and mitigation strategy (REMS) for extended-release and long-acting opioids. Available at http://www.fda.gov/drugs/drugsafety/information Bydrugclass/ucm163647.htm. Accessed November 19, 2012.

Staff Reports: Senators approve Manchin amendment to reclassify hydrocodone drugs. Saturday Gazette-Mail. Available at http://wvgazette.com/News/201205230316?page=1. Accessed January 24, 2013.

Walker EP. Pharmacy groups oppose reclass of hydrocodone. Medpage Today. Available at http://www.medpagetoday.com/Anesthesiology/PainManagement/33080. Accessed January 24, 2013.

Fiore K: FDA: Don’t tighten vicodin regulation. Medpage Today. Available at http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/36591. Accessed January 24, 2013.

FDA Panel Calls for Greater Restrictions on Hydrocodone Medscape Fran Lowry January 28, 2013. Available at http://www.medscape.com/viewarticle/778275. Accessed April 7,2013.

Pain & Policy Studies Group: University of Wisconsin-Madison. Available at http://www.painpolicy.wisc.edu. Accessed November 29, 2012.

CDC taking steps to combat opioid deaths. Atlanta Med-Sci Daily News. Available at http://asam-365.ascendeventmedia.com/Highlight.aspx?p=368&id=4452. Accessed November 29, 2012.

Human Rights Watch. Global State of Pain Treatment. Access to Palliative Care as a Human Right. US: Human Rights Watch, 2011.

Dubner R, Gold M: Colloquium on the Neurobiology of Pain. Washington, DC: National Academy of Sciences, 1999.

Mehendale AW, Patrick D, Goldman M: Managing chronic-pain patients in the new millennium: Clinical basis and regulatory viewpoint from Texas, USA. World Inst Pain. 2004; 4: 105-129.

Stannard C, Kalso E, Ballantyne J: Evidence-Based Chronic Pain Management. 5th ed. Oxford, England: John Wiley and Sons Ltd, 2010.

Engel GL: The need for a new medical model: A challenge for biomedicine. Science. 1977; 196(4286): 129-136.

Barnett JE, Shale AJ: The integration of complementary and alternative medicine (CAM) into the practice of psychology: A vision for the future. Prof Psychol: Res Pr. 2012; 43(6): 576-585.

Helme RB: Chronic pain. In Samuels M, Ropper AH (eds.): Samuel’s Manual of Neurologic Therapeutics. 8th ed. Philadelphia, PA: Lippincott, Williams, & Wilkins, 2010.

Genesis 3:16. King James Version. Available at http//www.searchthebible.com/old-ttestament/Genesis/genesis-chapterthree.htm. Accessed August 18, 2013.

Strong J: Exhaustive Concordance of the Bible. Madison, NJ: World Bible Publishers, 1991: 1290.

US Federal Law Pain Relief Promotion Act 2000. Available at http://www.gpo.gov/fdsys/pkg/CHRG-106shrg72844/pdf/CHRG-106shrg72844.pdf. Accessed August 18, 2013.

Gatchel RJ, Peng YB, Peter ML, et al.: The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychol Bull. 2007; 133(4): 581-624.

Gaskin DJ, Richard P: The economic costs of pain in the United States. J Pain. 2012; 13(8): 715.

Stewart WF, Ricci JA, Chee E, et al.: Lost productive time and cost due to common pain conditions in the US workforce. J Am Med Assoc. 2003; 290(18): 2443-2454.

Turk DC, Gatchel RJ: Psychological Approaches to Pain Management: A Practitioners Handbook. 2nd ed. New York, NY: The Guilford Press; 2002.

Poleshuck EL, Gamble SA, Cort N, et al.: Interpersonal psychotherapy for co-occurring depression and chronic pain. Prof Psychol Res Press. 2010; 41(4): 312-318.

Fishbain DA, Cutler R, Rosomoff HL, et al.: Chronic-pain-associated depression: Antecedent or consequence of chronic pain? A review. Clin J Pain. 1997; 13(2): 116-137.

Bair MJ, Robinson RL, Katon W, et al.: Depression and pain comorbidity: A literature review. Arch Inter Med. 2003; 163(20): 2433-2445.

Arnow BA, Hunkeler EM, Blasey CM, et al.: Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006; 68(2): 262-268.

Rudy TE, Kerns RD. Turk DC: Chronic pain and depression: Toward a cognitive-behavioral mediation model. Pain. 1988; 35(2): 129-140.

Turk DC, Okifuji A, Scharff L: Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts. Pain. 1995; 61(1): 93-101.

McWilliams LA, Cox BJ, Enns MW: Mood and anxiety associated with chronic pain: An examination in a nationally representative sample. Pain. 2003; 106(1-2): 127-133.

Bair MJ, Wu J, Damush TM, et al.: Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008; 70(8): 890-897.

McWilliams LA, Goodwin RD, Cox BJ: Depression and anxiety associated with three pain conditions: Results from a nationally representative sample. Pain. 2004; 111(1-2): 77-83.

Okifuji A, Turk DC, Curran SL: Anger in chronic pain: investigations of anger targets and intensity. J Psychosom Res. 1999; 47(1): 1-12.

Frohm KD, Beehler GP: Psychologists as change agents in chronic pain management practice: Cultural competence in the health care system. Psychol Serv. 2010; 7(3): 115-125.

Hoffman BM, Papas RK, Chatkoff DK, et al.: Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007; 26(1): 1-9.

Astin JA, Beckner W, Soeken K, et al.: Psychological interventions for rheumatoid arthritis: A meta-analysis of randomized controlled trials. Arthritis Care Res. 2002; 47(3): 291-302.

Vlaeyen JWS, Morley S: Cognitive-behavioral treatment for chronic pain: What works for whom? Clin J Pain. 2005; 21(1): 1-8.

De Jong JR, Vlaeyen JW, Onghena P, et al.: Reduction of pain-related fear in complex regional pain syndrome type I: The application of graded exposure in vivo. Pain. 2005; 116(3): 264-275.

Grossman P, Niemann L, Schmidt S, et al.: Mindfulness based stress reduction and health benefits: A meta-analysis. J Psychosom Res. 2004; 57: 35-43.

Williams KA, Petronis J, Smith D, et al.: Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005; 115(1): 107-117.

Cramer H, Lauche R, Haller H, et al.: A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5): 450-460.

Nestoriuc Y, Rief W, Martin A: Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment modalities. J Consult Clin Psychol. 2008; 76(3): 379-396.

Jensen MP. Hypnosis for chronic pain: A new hope. Pain. 2009; 146(3): 225-338.

Ray O: How the mind hurts and heals the body. Am Psychol. 2004; 59(1): 29-40.

Pert CB, Pasternack GW, Snyder SH: Opiate agonists and antagonists discriminated by receptor binding in brain. Science. 1973; 182: 1359-1361.

Hughes J, Smith TW, Kosterlitz HW, et al.: Identification of two related pentapeptides from the brain with potent opiate agonist activity. Nature. 1975; 258(5536): 577-580.

Kangawa K, Matsuo H: Alpha-neo-endorphin: A “big” Leuenkephalin with potent opiate activity from porcine hypothalami. Biochem Biophys Res Commun. 1979; 86(1): 153-160.

Minamino N, Kangawa K, Fukuda A, et al.: A new opioid octapeptide related to dynorphin from porcine hypothalamus. Biochem Biophys Res Commun. 1980; 95: 1475-1481.

Pasternak G: Opioid receptors: The early years. In Pasternak G (ed.): The Opiate Receptors. 2nd ed. New York, NY: Humana Press, 2011: 70-91.

Pathan H, Williams J: Basic opioid pharmacology: An update. Br J Pain. 2012; 6(1): 11-16.

Vallejo R, Barkin RL, Wang VC: Pharmacology of opioids in the treatment of chronic pain syndromes. Pain Physician. 2011; 14: E343-E360.

Trescot A, Datta S, Lee M, et al.: Opioid pharmacology. Pain Physician. 2008; 11(special issue): S133-S153.

Pradhan AA, Befort K, Nozaki C, et al.: The delta opioid receptor: An evolving target for the treatment of brain disorders. Pharmacol Sci. 2011; 32(10): 581-590.

Lufty K, Cowan A: Buprenorphine: A unique drug with complex pharmacology. Curr Neuropharmacol. 2004; 2(4): 395-402.

Todd V: Delta and kappa opioid receptors as suitable drug targets for pain. Clin J Pain. 2010; 26: S10-S15.

Rozenfeld R, Abul-Husn N, Gomes I, et al.: An emerging role for the delta opioid receptor in the regulation of mu opioid receptor. Sci World J. 2007; 7(special issue): 64-73.

Doverty M, Somogyi AA, White JM, et al.: Methadone maintenance patients are cross-tolerant to the antinociceptive effects of morphine. Pain. 2001; 93: 155-163.

Dunbar S, Yaksh TL: Concurrent spinal infusion of MK801 blocks spinal tolerance and dependence induced by chronic intrathecal morphine in the rat. Anesthesiology. 1996; 84: 1177-1188.

Trujillo KA, Akil H: Inhibition of morphine tolerance and dependence by the NMDA receptor antagonist MK-801. Science. 1991; 251: 85-87.

Trujillo KA, Akil H: Inhibition of opiate tolerance by noncompetitive N-methyl-D-aspartate receptor antagonists. Brain Res. 1994; 633: 178-188.

Sharma SK, Nirenberg M, Klee WA: Morphine receptors as regulators of adenylatecyclase activity. Proc Natl Acad Sci USA. 1975; 72: 590-594.

Zhang J, Ferguson SS, Barak LS, et al.: Role for G protein-coupled receptor kinase in agonist-specific regulation of muopioid receptor responsiveness. Proc Natl Acad Sci USA. 1998; 95: 7157-7162.

Zhang L, Yu Y, Mackin S, et al.: Differential mu-opiate receptor phosphorylation and desensitization induced by agonist and phorbolesters. J Biol Chem. 1996; 271: 11449-11454.

Compton P, Charuvastra VC, Kintaudi K, et al.: Pain responses in methadone-maintained opioid abusers. J Pain Symptom Manage. 2000; 20: 237-245.

Compton MA: Cold-pressor pain tolerance in opiate and cocaine abusers: Correlates of drug type and use status. J Pain Symptom Manage. 1994; 9: 462-473.

Doverty M, White JM, Somogyi AA, et al.: Hyperalgesic responses in methadone maintenance patients. Pain. 2001; 90: 91-96.

Compton P, Charuvastra VC, Ling W: Pain intolerance in opioid-maintained former opiate addicts: Effects of long-acting maintenance agent. Drug Alcohol Depend. 2001; 63: 139-146.

Hood DD, Curry R, Eisenach JC: Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg. 2003; 97: 810-815.

Sweitzer SM, Wong SME, Tjolsen A, et al.: Exaggerated nociceptive responses on morphine withdrawal: Roles of protein kinase C epsilon, and gamma. Pain. 2004; 110: 281-289.

Angst MS, Clark DJ: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology. 2006; 104(3): 570-587.

Mao J, Price D, Mayer D: Mechanisms of hyperalgesia and morphine tolerance: A current view of their possible interactions. Pain. 1995; 62: 259-274.

Raghavendra V, Tanga FY, DeLeo JA:. Attenuation of morphine tolerance, withdrawal-induced hyperalgesia, and associated spinal inflammatory immune responses by propentofylline in rats. Neuropsychopharmacology. 2004; 29: 327-334.

Chia YY, Liu K, Wang JJ, et al.: Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth. 1999; 46: 872-877.

Gardell LR, Wang R, Burgess SE, et al.: Sustained morphine exposure induces a spinal dynorphin-dependent enhancement of excitatory transmitter release from primary afferent fibers. J Neurosci. 2002; 22: 6747-6755.

Koppert W, Ihmsen H, Korber N, et al.: Different profiles of buprenorphine induced analgesia and antihyperalgesia in human pain model. Pain. 2005; 118: 15-22.

Mehendale AW, Goldman MP: Fibromyalgia or chronic persistent widespread pain or syndrome of myalgic encephalomyelopathy: What is it’s nature? Pain Pract. 2000; 2(1): 35.

Winfield JB: Fibromyalgia. Available at http://emedicine.medscape.com/article/329838-overview#a0156. Accessed October 27, 2012.

Van Ree JM, Gerrits MAFM, Vanderschuren LJMJ: Opioids, reward and addiction: An encounter of biology, psychology, and medicine. Pharm Rev. 1999; 51(2): 341-396.

Ballantyne JC, Shin NS: Efficacy of opioids for chronic pain: A review of the evidence. Clin J Pain. 2008; 24(6): 469-478.

Noble M, Tregear SJ, Treadwell JR, et al.: Long-term opioid therapy for chronic noncancer pain: A systematic review and meta-analysis of efficacy and safety. J Pain Symptom Manage. 2007; 35: 214-228.

Manchikanti L, Singh A: Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse and nonmedical use of opioids. Pain Physician. 2008; 11(theme issue): S63-S88.

Martell BA, O’Connor PG, Kerns RD, et al.: A systematic review: Opioid treatment for chronic back pain: Prevalence, efficacy, and association with addiction. Ann Intern Med. 2007; 146(2): 116-127.

Trescot AM, Helm S, Hansen H, et al.: Opioids in the management of chronic non-cancer pain: An update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician. 2008: 11(theme issue): S5-S62.

Ballantyne JC, Mao J: Opioid therapy for chronic pain. New Engl J Med. 2003; 349: 1943-1953.

Deshpande A, Furlan AD, Mailis-Gagnin A, et al.: Opioids for chronic low-back pain (Review). Cochrane Collab. 2010; 5: 1-13.

Manchikanti L, Abdi S, Atluri S, et al.: American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I–Evidence assessment. Pain Physician. 2012; 15: S1-S66.

Portenoy RK: Opioid therapy for chronic non-malignant pain: Current status. In Fields HL, Liebeskind JC (eds.): Pharmacological Approaches to the Treatment of Chronic Pain: New Concepts and Critical Issues. vol 1. IASP Press: Progress in Pain Research and Management, 1994.

Ballantyne JC: Opioid analgesia: Perspectives on right use and utility. Pain Physician. 2007; 10: 479-491.

Manchikanti L, Pampati V, Damron K, et al.: Evaluation of variables in illicit drug use: Does a controlled substance abuse screening tool identify illicit drug use? Pain Physician. 2004; 7: 71-75.

Prescription painkiller overdoses in the US Centers for Disease Control. Available at http://www.cdc.gov/features/vitalsigns/painkilleroverdoses/. Accessed December 5, 2012.

Samuels MA: Chapter 10, Samuel’s Manual of Neurologic Therapeutics. 8th ed. Lippincott Williams & Wilkins, 2010. ISBN 979-1-60547-575-2.




DOI: https://doi.org/10.5055/jom.2013.0185

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