UVM Integrative Lecture Series: “Opioids and Chronic Pain: Cultural Myopia and the Big Picture”
Lecture Type: Online Video (Link Here)
Time: 62 minutes 04 seconds
Date: October 30, 2017
Speakers: Tracy Jackson, M.D.
Topic: Chronic Pain
Introduction
Dr. Tracy Jackson, M.D., presents a lecture on the big picture of chronic pain for the University of Vermont Laura Mann Integrative Health Care Lecture Series. Dr. Jackson is an associate professor of Anesthesiology for the Division of Pain Medicine at Vanderbilt University Medical Center. She is also the CEO of Relief Retreats and the founder of campaign.org. She has a background interacting with traditional Chinese Medicine while traveling abroad, is board certified in Addiction Medicine, and has training in yoga and acupuncture.
This lecture was recorded live and posted to YouTube. You can view the lecture directly by clicking the link here.
You can download the PowerPoint presentation for this lecture by clicking the link here.
Pain and the Brain
Pain is intrinsically linked to brain circuitry. According to Dr. Jackson, our brains are trying to constantly answer the question, “Am I safe?” Three basic centers of the brain related to this concept. The first is the prefrontal cortex, which is the logical decision-making center of the brain. The second is the hippocampus, which regulates our emotions and memory. The third is the amygdala or the fear center of the brain. When do not feel safe, or when we are stressed, the amygdala and hippocampus take control as part of our fight or flight response. This overpowers our prefrontal cortex. We release cortisol and adrenaline, causing the stress response. However, this same response is turned on whether you are facing a life-or-death scenario or whether it is a minor stressor like daily traffic. When it comes to pain, these same centers of the brain are activated.
The link between the amygdala and hippocampus is important to the process of developing sensitization to pain. The emotions we feel, related to the hippocampus, in response to certain stressful events, can result in physical pain. The example Dr. Jackson uses is a child who fears going to school because they are bullied there. Oftentimes, children complain that they have stomach pain in response to this stress. Similarly, adverse childhood events (ACEs), such as physical or emotional abuse, sensitizes our brain so that when we get older we are more susceptible to experiencing pain. The basic idea here is that the mind and body are intrinsically important to treating pain. Although we cannot change the past traumas we have experienced, we can retrain our brains. Dr. Jackson shares hope that the structure and function of the human brain can change over time to improve health outcomes.
Pain Medicine
According to Dr. Jackson, there is a need to improve how the healthcare system treats pain. At the time of this lecture, she found that the average medical student receives two hours of formal training on pain. Treatment options covered by insurance include medications, such as opioids or NSAIDs, and interventions, like surgery. This system ignores the mind-body interaction in pain. Instead, rehabilitative and cognitive therapies should be relied upon more so in the treatment of pain.
Rehabilitative therapies include a more musculoskeletal approach to treatment that uses physiatry and physical therapy. It is possible to include corrective strengthening exercises, trigger point therapies, massage, and more to help manage this pain.
Additionally, chronic pain has been associated with mood disorders, such as major depression and anxiety. Below is a slide taken from Dr. Jackson’s PowerPoint, which shows the predictors of pain and medication use. The top three of these are anxiety, physiological depression, and preoperative pain.
Overall, Dr. Jackson reports that a combination of the following therapies can be used with harm reduction:
- Cognitive restructuring
- Coping skills training
- Movement
- Mindfulness
- Trauma counseling
- Functional rehabilitation
- Community
- Compassion/sense of safety
“We want it faster, better, more convenient . . . there is no quick fix”
(Jackson, 2017)
Transforming Treatment
Why is this chronic pain an issue? First, people continue to experience pain without relief using current treatment protocols. Second, opioids are addictive medicines, which patients can overdose on. According to Dr. Jackson, “approximately one in five with chronic pain prescribed opioids had lifetime overdose.” Third, there is a societal burden of pain. Out of 12 factors causing disability, pain account for the top 8 of these. According to Dr. Jackson, our systems are not managing pain and other chronic illness well. However, if pain treatment can incorporate integrative medicine and functional rehabilitation, we can improve health outcomes. According to one study using functional rehabilitation to treat patients with chronic pain, 2/3 of the participants were able to return to work and healthcare costs were reduced by 66%.
Moving forward, innovative programs can be created to help treat pain and target individuals at risk for opioid addiction. This may include a triage center to identify chronic pain, telemedicine protocols to ensure individuals are followed for long-term management by doctors and health coaches, and offering both inpatient and outpatient programs that incorporate both education and treatment for those that need help getting off opioids. Working in partnership with patients to identify their pain, address the underlying psychosocial dysfunction, and empower involvement in long-term treatment, physicians can make a difference in the widespread impacts of chronic pain today.
Concluding Thoughts
Chronic pain continues to be a huge issue for individuals and society at large. Dr. Jackson shares a big-picture view of the current state of chronic pain treatment and where changes can be made to improve health outcomes. I encourage you to watch the lecture for yourself, access the studies cited in this presentation, and learn about Dr. Jackson’s work in chronic pain and addiction.
Check out the lecture video here.
Download the PowerPoint presentation here.
Visit the UVM Integrative Lecture Series home page here.
Citation
Jackson, T. (2017, October 20). Opioids and Chronic Pain: Cultural Myopia and the Big Picture. [Lecture Recording]. University of Vermont Laura Mann Integrative Health Care Lecture Series. https://www.youtube.com/watch?v=o-r9isTSlgQ