A common pharmacological intervention strategy for persistent pain includes the use of opioids such as oxycodone, hydrocodone, codeine, and morphine. Most people get at least temporary and partial pain relief from opioids hence it is a $13-billion-a-year industry (That’s billion, with a B!). However, the potential risks versus benefits of their use for chronic pain is continuously being questioned.

Studies spanning over a decade have unfortunately shown that long-term opioid therapy did not result in long term improvements in pain, function or quality of life

“Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain” (Krebs et al 2018)

“There is no evidence that pure opioids are effective in fibromyalgia” (Littlejohn et al 2016)

So do we have an opioid epidemic or a pain epidemic?

Let’s assume there is an outbreak of pneumonia and the antibiotics normally prescribed fail to work to treat this particular type of pneumonia. In fact the more antibiotics are prescribed, the worse the pneumonia symptoms become.

In this hypothetical scenario, do we have an antibiotic epidemic? Or would you say that we have a pneumonia epidemic?

Sure many more people than ever in our history are taking opioids, but the drugs are not really the problem. The reason they need to take it is the problem: pain, both physical and emotional.

In my paper titled, “The best opioids don’t come in a bottle but are found in small enjoyable activities.”, which is available on www.aptei.ca I will discuss alternative options to exogenous (externally provided) opioids.

Physical activity may be the single best mode of releasing endogenous (internally made) opioids.

“…long-term voluntary wheel running (in rats) produces analgesia through activation of endogenous inhibitory mechanisms that include opioids… We propose that exercise resets the nervous system, so that subsequently painful stimuli normally perceived as painful in sedentary individuals, are not perceived as painful in active individuals.” (Brito et al 2017)

It is hypothesized that with the release of the endogenous opioids, even if pain is not eliminated or immediately reduced, the participation in enjoyable life activities may reduce the suffering associated with persistent pain.

“I don’t mind pain, so long as it doesn’t hurt.” -Oscar Wilde

Reference: Jam B The best opioids don’t come in a bottle but are found in small enjoyable activities. https://www.aptei.ca/clinical-articles/

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