Treating chronic pain: the need for non-opioid options

Abstract

Chronic pain is a prevalent problem that exacts a significant toll on society. The medical system has responded to this issue by implementing pain management services centered on opioid pharmacotherapy. However, for many chronic pain patients, the analgesic efficacy of long-term opioids is limited. Moreover, chronic exposure to opioids can result in opioid misuse, addiction, and risk of overdose. As such, non-opioid treatment options are needed. This article first provides a selective review of cognitive, affective, and psychophysiological mechanisms implicated in chronic pain to be targeted by novel non-opioid treatments. Next, it briefly details one such treatment approach, Mindfulness-Oriented Recovery Enhancement, and describes evidence suggesting that this intervention can disrupt the risk chain linking chronic pain to prescription opioid misuse.

Keywords::

• addiction
• chronic pain
• mindfulness
• neurocognitive
• opioid misuse

Financial & competing interests disclosure

This work was supported by grant R34DA037005 awarded to E.L. Garland. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic pain is a prevalent health condition that is often treated with opioids.

• Although opioids can be highly effective in treating acute pain, for many patients, long-term opioid analgesia inadequately addresses the symptoms of chronic pain.

• More than 10% of chronic pain patients are at risk for misusing prescription opioids.

• Chronic pain may be subserved by maladaptive cognitive processes, dysregulated emotional responses and heightened sympathetic nervous system activation.

• Opioids do not directly target the cognitive mechanisms implicated in chronic pain, and due to their effects on the mesocorticolimbic dopamine system, may lead to development of addictive habits.

• Nonopioid treatment approaches for chronic pain might achieve optimal efficacy by integrating cognitive training regimens such as Mindfulness-Oriented Recovery Enhancement with somatic therapies and novel pharmacological agents.