How Nurses are Fighting the Worldwide Opioid Crisis

For many chronic pain sufferers the only thing that brings relief are prescription opioids. The trouble with opioids is that they are inherently addictive, and it can be difficult to wean long term patients. A 2014 NIH journal article estimated that the number of people addicted to opioids worldwide was between twenty-six and thirty-six million. What most people that suffer chronic pain aren’t aware of is that there are many holistic ways to treating this pain without having to suffer the possibility of becoming addicted to a prescription drug. Some that have been introducing these holistic ways in healthcare are nurses, making them the front-line of countering this crisis affecting millions.

How the Brain Processes Pain

Pain is the body’s alarm system. When an infection is present, or an accident happens this is the body’s way of signaling that something is wrong and that help needs to be sought. But how precisely does that work? Our bodies have thousands of nerves that carry signals to the brain. There are structures in the soft tissue of the body known as nociceptors that are the nerve endings of, these lay in the hands, feet and just about anywhere else that we have soft tissue, and there are thousands of them per square inch of soft tissue. When these structures are damaged by some accident, for instance when someone burns their finger on a stove or a match these structures send a pain signal that travels up the nerve to the spinal cord, and from there to another nerve depending on the body part affected, to the brain. In order for the brain to respond correctly, it must be able to identify the corresponding body part.

Most of the time pain starts off very sharp and then gradually dies down to a dull throb. This is because pain is transmitted by two different types of nerve fibers in the body. A-delta fibers are responsible for the first sharp pain signal that we get, the first indication that something is wrong. Gradually that begins to fade and C fibers take over the dull throbbing that conveys that the pain is still there, now acknowledged by the brain, but that steps must now be taken to eliminate cause of the pain. 

Research has shown that the way people experience pain is dependent on a host of factors that can range from personal experience to cultural heritage. This means that a broader amount of areas in the brain are involved in pain processing than one would imagine. When speaking of just the involvement of the body, however, one of the first places that is involved with pain is the reticular formation that is located on the brain stem and the first stop on the pain reception train from the spinal cord. The reticulum formation occurs when we are either conscious or asleep. It’s made up of neurons, ascending and descending fibers. How is the reticulum formation important to pain processing though? Even as it resides on the brain stem it’s reach extends into the central nervous system allowing for control over heart rate, respiration, blood pressure and other vital signs that are affected when accidents occur. This is the first place that the pain signal reaches after the spinal cord, it’s what notifies you of pain.

Pain will then continue to the thalamus as it plays the role of a relay station in a sense for all somatosensory impulses entering the cerebral cortex. It receives sensory impulses from all over the body and interprets them as pain, touch or temperature and then sends it to the cortex. It’s composed of three distinctly different set of nuclei that have their own responsibilities.The sensory nuclei are the relays that send signals of specific sensory sensation by passing it on to the correct cortical area. Association nuclei receive the input from areas of the cortex, it then projects this input back to the cortex to generalize the associated areas. Non-specific nuclei receive input from the cortex, it then projects the input back to the cortex but in a much less specific manner than association nuclei.

How Opioid Addiction Occurs

Currently more than seventy-six million Americans are being treated for chronic pain disorders. This number not only includes people that suffer from such disease and disorders like fibromyalgia, arthritis, sciatica, spinal stenosis but also patients that have chronic pain as secondary symptoms to things like cancer or depression.  Most commonly physicians will prescribe the drugs Fentanyl, Hydrocodone or Hydromorphone to patients with pain as they are the fastest way for them to find relief.

However, long term use of these drugs are not recommended because of their addictive properties and the heavy sedation and impairment that they cause so physicians will often only prescribe them for short term use. Unfortunately the pain will come back once the patient stops the medication so it may be advisable to try alternative therapies before moving on to opioids.

When pain medication is taken, the chemicals in the medications sends a signal to the brain that it should not feel the pain in the area in which the pain is occurring. Over time with continued use, the brain will start to ignore the signal and this is when the pain will come back so to speak. When this happens, most patients will either be prescribed a higher dosage of the medication they’ve been taking or move on to something even stronger. It them becomes a cycle as the brain continues to get used to the medication or the dosage and the dosage gets so high that they are left in a fog that leaves them unable to function in daily life, this is addiction.

Many chronic pain sufferers would prefer to not take opioids due to the risk of addiction, and It is possible to be pain free without starting or becoming addicted to opioids. It takes a little more work, effort and dedication, but with help from health professionals it is possible. Health professionals such as nurses are key in educating patients on not only how to manage chronic pain symptoms, but how to view their pain on a continuum as all pain does not require an opioid for management or relief.

Nurses on the Front Lines of the Opioid Crisis

Being one of the most integral parts of patient care, nurses ask themselves a few questions before administering opioids to patients. First, does the level of pain dictate an opioid for relief or can something else be used just as effectively without the danger or addiction? Second, nurses should always check the Prescription Drug Monitoring database to find a patient's opioid prescription history to make sure that they are not dealing with someone who is already addicted and abusing prescriptions. Along with being wonderful professionals, are great teaching resources that can help teach patients how to responsibly dispense their medications, encourage treatment for those that are at risk or already addicted to prescription opioids, they can teach patients to relaxation therapies to minimize the risk of anxiety caused by the fear or boomeranging pain, and teach patients how to use alternative methods for relieving their pain that do not depend on opioids.

Living Without Pain Naturally

Some of the methods that can be used include acupuncture, which is often used to treat pain in other situations, and it can be used to minimize chronic pain but the gain seems to be modest at most. Radiofrequency ablation, nerve block, spinal fusion, supplements, holistic massage and a host of other pain relief methods also seem to benefit many. However the risk benefit ratio in natural methods is low and most are perfectly safe practices when performed by someone who is well trained in their craft. Chronic pain is difficult to manage for most, so anything that provides even the slightest amount of relief is welcomed for patients.