Chronic pain is classified as any pain that lasts more than 3 months. This can be related to an injury that doesn’t heal properly and continues to cause pain or a number of degenerative conditions such as osteoarthritis. In the case of acute pain that transitions to chronic conditions, pain signals still activate in the body for months or even years after recovery is expected to take place. Chronic pain can affect the quality of life for many patients. It can reduce their ability to perform day-to-day functions normally and even lead to depression.

Over 100 million people in the United States experience chronic pain. 1.5 billion people worldwide experience this type of pain.

Chronic pain affects more people than diabetes. In the U.S. diabetes affects approximately 28.5 million people. The statistics for chronic pain also influence the nation’s workers’ compensation program, missed work from injured employees, and costs the country billions of dollars in medical care each year.

Because of the variety of conditions that can cause chronic pain, there is no established treatment plan. Each case is assessed individually and treated accordingly, often requiring several methods before an effective solution is found. Interventional procedures may include surgical correction, injections of medication into the affected area of the body, and other invasive procedures. Currently, doctors may even use interventional procedures to determine the cause of their patients’ pain so they can better treat it in the long-term.

Alternative treatments can also be helpful. These may include physical therapy to strengthen the surrounding muscles and relieve pain, or treatments such as acupuncture, chiropractic care, or biofeedback training. However, these alternative solutions may only be effective in a certain subset of patients. Medications are also frequently used by doctors to control the pain symptoms in their patients.

Current medications used for chronic pain include:  

  • NSAIDs: Non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin, are frequently used for acute conditions as well as to control flare-ups of chronic conditions. They do not necessarily make good long-term treatments but can be used to help control pain in the short-term. Many NSAIDs are available over-the-counter.
  • Opioids: These narcotic medications are also used for acute pain but can be effective for some types of chronic pain as well. However, the primary concern with opioids, such as hydrocodone, is the risk of developing a tolerance or addiction. Opioids can block pain for a while until the body no longer responds to the dose and more medication needs to be taken to receive the same results.
  • Antidepressants: For some patients, antidepressants work well for pain management. Even when depression isn’t a factor, antidepressants have been proven effective for some patients who experience chronic pain from arthritis, nerve pain related to diabetes, migraines, fibromyalgia, and more.
  • Muscle relaxants: Because they depress the central nervous system, muscle relaxants have also shown promising results in patients dealing with some forms of chronic pain. They appear to be most effective against low back pain and other forms of chronic musculoskeletal pain.

However, many of these current drug-based treatments have side effects that can cause bigger problems for patients along with their chronic pain conditions.

At the beginning of 2014, scientists from the Scripps Institute in Florida released information about drugs that may revolutionize the treatment of pain and several other conditions. A pair of compounds, known as biased agonists, work together to activate the body’s opioid receptors without aggravating beta arrestins which cause depressed moods and inhibits some of the positive therapeutic effects of pain medications. Laura Bohn, a TSRI associate professor who led the study, notes:

“Compounds that act at kappa receptors may provide a means for treating addiction and for treating pain; however, there is the potential for the development of depression or dysphoria associated with this receptor target. There is evidence that the negative feelings caused by kappa receptor drugs may be, in part, due to receptor actions through proteins called beta arrestins. Developing compounds that activate the receptors without recruiting beta arrestin function may serve as a means to improve the therapeutic potential and limit side effects.”

This compound can help drugs target exactly the right receptors without causing negative side effects, such as depression, which can quickly derail the treatment plan the drugs were meant to enhance.

While these compounds are still in the beginning stages of development, researchers are hopeful that they will prove beneficial and become something that can be used in conjunction with current treatments to increase the overall effectiveness in patients, without many of the dangerous side effects. The idea that some drug-based treatments for chronic pain can be improved to not include some of the more counterproductive side effects for patients is very promising.

In fact, the elimination of depression from the list of side effects of these medications may be especially important for treating patients with addiction considering that mood swings are often a core cause of relapses. The same may be true for pain management. Chronic pain can already affect a patient’s mood negatively and create a cycle of depression which these medications contribute to as well.

Finding a way to reduce the depression response in the body from the use of these drugs could be a groundbreaking and essential breakthrough.

While chronic pain can be treated with a number of non-drug solutions, medications including opioids are still prescribed regularly to control the symptoms of several chronic disorders. Patients who rely on these treatments may expect some improvement in their overall effectiveness and a reduction in the side effects of depression once these compounds receive more attention, study, and development. Used in conjunction with alternative therapies, such as biofeedback training or acupuncture, these drugs could even help improve the overall condition and quality of life for individuals suffering from several different forms of chronic pain.

We want to hear from you: what has been your experience with chronic pain, medications, and the side effects that they cause, including depression?

Image by Victor via Flickr


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