This week’s blog on my homepage discussed the downfalls of basing healthcare on diagnosis and managing diseases and sickness symptoms. In it, I reviewed the importance of individualizing treatment and considering the interplay between genes and environment. In fact, I reported on a pivotal study that provided evidence that even in those with a genetic mutation that could result in disorders such as cystic fibrosis and Tay-Sachs disease, there were individuals found who were healthy in spite of them.
We have a current epidemic now in painkiller abuse. Recently, Health Day reported:
The Obama administration announced Tuesday additional measures in its $1.1 billion funding request to expand medication-based treatment for Americans addicted to prescription painkillers and heroin.
President Barack Obama is scheduled to propose the measures at the National Rx Drug Abuse & Heroin Summit in Atlanta. The White House said the increased initiative could offer hope to tens of thousands of Americans addicted to prescription painkillers, such as OxyContin, Vicodin and Percocet, as well as illegal drugs like heroin.
Therefore, our reliance on medications to soothe our pain has financial and social implications. For example, it has been shown that opioids may cause changes in the brain in a small 2010 study, though the authors hypothesized this may be reversible:
Following the month of morphine administration, reduced gray matter was observed in the right amygdala. The amygdala, together with the hippocampus, drive reward-related learning processes via modulatory influences on the nucleus accumbens [17, 21]. The
amygdala is involved in drug-induced associative learning, drug craving, reinforcement, the development of dependence, and the experience of acute withdrawal… Gray matter increase was widely-distributed throughout the brain and, in contrast to regions demonstrating volumetric decrease, was located outside of reward-processing networks.
Furthermore, it isn’t just a concern for heroin and other painkillers. Many are using common over-the-counter medications to control pain that may have negative side effects, such as harming the brain. According to a recent article in Science Daily:
It’s been known for more than a century that acetaminophen is an effective painkiller, but according to a new U of T study it could also be impeding error-detection in the brain.
The research, authored by a team including postdoctoral fellow Dan Randles and researchers from the University of British Columbia, is the first neurological study to look at how acetaminophen could be inhibiting the brain response associated with making errors.
“Past research tells us physical pain and social rejection share a neural process that we experience as distress, and both have been traced to same part of the brain,” says Randles.
Recent research has begun to show how exactly acetaminophen inhibits pain, while behavioural studies suggest it may also inhibit evaluative responses more generally. Randles own past research has found that people are less reactive to uncertain situations when under the effect of acetaminophen.
It’s a sad state in America when interventions which may be effective and have positive side effects are
overlooked. For example, I discussed how mindfulness practices can assist with low back pain. A 2013 study reviewed some of the evidence on how meditation may affect pain processing looking at more than just the physical aspect of pain perception:
The cognitive modulation of pain is influenced by a number of factors ranging from attention, beliefs, conditioning, expectations, mood, and the regulation of emotional responses to noxious sensory events. Recently, mindfulness meditation has been found attenuate pain through some of these mechanisms including enhanced cognitive and emotional control, as well as altering the contextual evaluation of sensory events. This review discusses the brain mechanisms involved in mindfulness meditation-related pain relief across different meditative techniques, expertise and training levels, experimental procedures, and neuroimaging methodologies. Converging lines of neuroimaging evidence reveal that mindfulness meditation-related pain relief is associated with unique appraisal
cognitive processes depending on expertise level and meditation tradition. Moreover, it is postulated that mindfulness meditation-related pain relief may share a common final pathway with other cognitive techniques in the modulation of pain.
Another recent study showed how mindfulness may also be helpful in emotional pain. HealthDay reported:
This study included 23 U.S. veterans of the Iraq and Afghanistan wars who all received some form of group therapy. After four months of weekly sessions, many had reductions in their PTSD symptoms.
However, some of the participants received mindfulness training, and only those veterans showed brain activity changes that could be detected on functional MRI brain scans. Before mindfulness training, when the veterans with PTSD were resting quietly, they had extra activity in brain regions involved in responding to threats or outside problems, the study authors said.
Pain is isolating and can have implications in other diseases, such as an increased risk of heart disease. This cycle continues of not looking at the need for connecting all the dots and the whack-a-mole medicine game of suppressing symptoms.
Most doctors may not ask you about another tool used in healing by more than half Americans- prayer. Shouldn’t faith and belief be factored in and incorporated into the art of medicine along with the science? Maybe then we’d really have true holistic, integrated, healthcare. I think it’s coming, but we still have a way to go.
Augliere B. Mystery factors protect lucky few from severe genetic disorders: Massive genomic study
picks up disease-linked mutations in otherwise healthy people. Nature. 11 April 2016. http://www.nature.com/news/mystery-factors-protect-lucky-few-from-severe-genetic-disorders-1.19719
Steele M. Obama Administration Steps Up Efforts to Beat Painkiller, Heroin Epidemic. Health
Day. March 29, 2016. http://consumer.healthday.com/mental-health-information-25/addiction-news-6/obama-steps-up-efforts-to-beat-painkiller-heroin-epidemic-709474.html
University of Toronto. Is a popular painkiller hampering our ability to notice errors? ScienceDaily. 8 April 2016. <www.sciencedaily.com/releases/2016/04/160408163734.htm>.
Younger JW, Chu LF, D’Arcy N, Trott K, Jastrzab LE, Mackey SC. Prescription opioid analgesics rapidly change the human brain. Pain. 2011;152(8):1803-1810. doi:10.1016/j.pain.2011.03.028.
Rettner R. Mindfulness Meditation May Reduce Low Back Pain. Huffington Post. March 24, 2016. http://www.huffingtonpost.com/entry/mindfulness-meditation-may-reduce-low-back -pain_us_56f4279de4b04c4c37619965
Zeidan F, Grant JA, Brown CA, McHaffie JG, Coghill RC. Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain. Neuroscience letters. 2012;520(2):165-173. doi:10.1016/j.neulet.2012.03.082.
Preidt R. Mindfulness Training May Ease PTSD. HealthDay. April 1, 2016. http://consumer.healthday.com/cognitive-health-information-26/brain-health-news-80/mindfulness-training-can-ease-ptsd-709555.html
Reinburg S. Lonely, Isolated People May Be Prone to Heart Disease, Stroke. Health Day. April 19,
Preidt R. Most Americans Turn to Prayer for Healing, Survey Finds. Health Day. April 22, 2016.