We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis

Abstract

The opioid crisis’ pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis’ toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.

Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study

“…There are indications that exposure to childhood trauma may increase the risk of persistent pain, although most studies on the subject assess childhood trauma retrospectively, 21 , 63 possibly introducing bias, 20 , 45 and prospective findings are conflicting. 43 , 59 , 60 Trauma reactions such as sleep disturbances, hypervigilance, and avoidance are symptoms considered to be relevant for the maintenance and exacerbation of pain conditions, 7 , 10 , 38 , 51 , 53 , 56 and our finding that post-traumatic stress symptoms were related to higher prescription rates in young adulthood among trauma-exposed participants aligns with this. Childhood interpersonal trauma is considered a predisposing factor for alterations in pain signaling leading to chronic pain.…”

“…This study was conducted in a geographical region without metropolitan areas and with low immigration 39 ; however, previous studies have found similar rates of long-term opioid use regardless of such characteristics. 58 Although health care is highly accessible and affordable in Norway, the associations revealed in this study seem to conform with patterns found in populations with different health care systems, 6,7,58,64 and we therefore consider that these associations may be generalized to other populations. The universal mechanisms outlined above also supports the generalizability of results across populations with different prescription rates.…”

“…The overlap of trauma exposure and a higher symptom load of pain is increasingly recognized. 7 , 30 A trauma-informed approach to pain management could help identify the best treatment for each patient and may be particularly important for young people. This study showed that several young people exposed to childhood trauma turned to health care services for help with pain relief.…”

“…All the described analyses were adjusted for the variables age, sex, household structure , and family economy as reported in adolescence. 7 , 46 Analyses for prescription analgesics in adolescence were additionally adjusted for pubertal development . 16 , 47 Separate and unadjusted zero-inflated negative binomial regression analyses were run to show the association of background variables to the outcomes.…”

“…For the subsample reporting trauma exposure, symptoms reported in adolescence were assessed in separate zero-inflated negative binomial regression analyses for the number of analgesics prescriptions filled in adolescence and young adulthood All the described analyses were adjusted for the variables age, sex, household structure, and family economy as reported in adolescence. 7,46 Analyses for prescription analgesics in adolescence were additionally adjusted for pubertal development. 16,47 Separate and unadjusted zero-inflated negative binomial regression analyses were run to show the association of background variables to the outcomes.…”