There should be a word for the loneliness and fear of chronic pain -- the “can’t sleep, can’t move and can’t stand it” fear in the middle of the night that the excruciating stabbing or ache will never get better. Roughly 25 million people in the U.S. have chronic pain, the CDC says. In Shots this week we check in with patients and doctors who are working hard to ease the suffering without risking the addiction to opioids that has ruined so many lives.
When Opioids Are The Right Answer Jon McHann, a middle-aged truck driver, developed excruciating pain after surgery to repair a bulging disc. Ten years later he is still struggling. Some days his pain is through the roof, he tells NPR’s Allison Aubrey. “I can’t open my eyes because I know if I blink, it’s going to hurt.” Opioids -- first methadone and now Percocet -- are the only treatments that have so far helped him, he says. He has tapered his dose over the years, not escalated.
Dr. Stefan Kertesz, a specialist in addiction medicine and professor at the University of Alabama -- who says he has never taken money from a drug company promoting opioids and never will -- tells Aubrey that until drugs are developed that have less potential for addiction, opioids are still the right answer for some patients, if prescribed and used with care. Meanwhile, he and other leading pain specialists are continuing to work with patients individually to reduce their dependence on opioids.
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Codeine Poses A Special Risk To Kids Some children are “ultra-metabolizers” of codeine, research shows, and that means their blood levels of the opioid can rise rapidly. Doses of codeine cough syrup that may be safe for some can be deadly for others, by suppressing breathing. “You’re basically rolling the dice when you prescribe codeine,” pediatrician Kao-Ping Chua of the University of Michigan tells NPR’s Greta Jochem. Prescribing that drug or tramadol -- another opioid -- to children under 12 “should be a zero event,” he says. But Chua’s study this week notes that despite repeated FDA warnings, too many doctors are still prescribing codeine or tramadol to kids after a tonsillectomy.
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Beyond Opioids: The Science Of Pain Brain researchers think one way to solve the opium addiction problem would be to find a drug that eases pain without engaging the brain’s pleasure centers. Some substances in a snail's venom look promising. Other scientists are looking for ways to dampen certain brain circuits. Fear, isolation and depression amplify chronic pain, pharmacologist Edward Bilsky of Pacific Northwest University Health Sciences tells NPR’s Jon Hamilton.
"If a person in pain stays home instead of going to their mahjong group, that feeds an escalation in pain," Bilsky says. There’s now a lot of evidence that emotion controls pain’s intensity.
Beware Some ‘Natural’ Substitutes For Opioids Looking for an alternative to opioids is natural, but the Food and Drug Administration this week issued a warning against trying the herbal pain reliever Kratom, a supplement sold online and derived from a plant that grows in Asia.
Some people say the supplement has eased their chronic pain and even helped with withdrawal symptoms of opioids.
But as NPR’s Rob Stein reports, the FDA has determined that, for now, there's insufficient evidence the supplement works to treat addiction or other problems and … growing evidence it can be dangerous. “Kratom may cause seizures, liver damage and withdrawal symptoms,” Stein reports. At least 36 deaths have been linked to the drug, according to the FDA, which has begun seizing supplies of Kratom and taking steps to prevent its import, pending further review.
Have you found success with treatments for pain that don’t involve supplements or drugs? We’d love to hear from you about what you’ve found works and what doesn’t, or about other topics you'd like to see in NPR's health coverage. We're listening. Write to us here: shots@npr.org.
Your Shots editor, Deborah Franklin
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