Pain and Substance Use Disorder

Question 1

Name three different neurotransmitter pathways involved in pain

Answer 1

Glutamatergic
Dopaminergic
GABAergic

Question 2

What does decreased dopamine cause (such as the case in withdrawal)

Answer 2

Depression
Grief
Loss
Lethargy
Amotivation

Question 3

What does increased noradrenaline cause (such is the case in withdrawal)

Answer 3

Anxiety
Insomnia 
Worry
Perseveration
Agitation 
Aggression
Activation of traumatic memories

Question 4

What are long term brain changes cause by chronic pain, substance use, and mental health issues

Answer 4

Metabolic activity
Neurotransmitter release
Gene expression
Receptor sensitivity and available 
Connectivity
Cue responsiveness

Question 5

How does alcohol binging set up the brain for chronic pain

Answer 5

Acutely alcohol acts as an analgesic
Increased anxiety and hyperalgesia set in
This worsening pain state promotes drinking to obtain pain relief, which worsens the pain
Binge drinking, emotional trauma, and injury can each heighten the sensitivity to pain and anxiety, increasing the likelihood of alcohol use disorder, major depressive disorder/generalized anxiety disorder, chronic non-cancer pain

Question 6

What can opioids cause?

Answer 6

Death
Overdose
Myocardial infarction 
Sleep apnea
Opioid use disorder
Motor vehicle accidents
Testosterone suppression

Question 7

What is withdrawal-associated injury site pain (WISP)

Answer 7

It is a phenomenon where healed remote injury sites can hurt again during opioid withdrawal. This pain can vanish when withdrawal is over.

Question 8

What are some mitigators for hyperalgesia and withdrawal-induced hyperalgesia

Answer 8

Opioid rotation, lowering or elimination
NMDA antagonists (ketamine, traxoprodil)
NSAIDs (ketorolac, ibuprofen, COX-2 inhibitors)
Gabapentinoids (gabapentin, pregablin)
Alpha-adrenergic blockers (clonidine); beta-blockers (propranolol)
Melatonin, lidocaine, ondansetron, endogenous cannabinoids
Microglia TLR-4 antagonists (enantiomers of Bali one and naltrexone, ibudilast, minicycline
Neurosteroids (progesterone)

Question 9

Non-pharmacological pain treatment options

Answer 9

Exercise
Chiropractic/manipulation
Acupuncture
Multidisciplinary rehabilitation 
Psychological therapy 
Massage
Yoga
Mindfulness-based stress reduction 
Tai chi