Sensitized brain response to acute pain in patients using prescription opiates for chronic pain: A pilot study

Logan T. Dowdle, Jeffrey J. Borckardt, Sudie E. Back, Katherine Morgan, David Adams, Alok Madan, Wendy Balliet, Colleen A. Hanlon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Chronic opiate use leads to a sensitized behavioral response to acute pain, which in turn, leads to escalating doses of opiates. This study was designed to test the hypothesis that chronic opiate usage is also associated with a sensitized neurobiological response to acute pain in individuals that have used prescription opiates for 6 or more months. Methods: Fourteen patients with non-alcoholic chronic pancreatitis that have been taking prescription opiates for 6 or more months and 14 gender matched, non-opiate using controls were enrolled. Functional neuroimaging data was acquired while participants received blocks of thermal stimulation to their wrist (individually-tailored to their pain threshold). Results: Self-reported pain was significantly greater in opiate using patients (3.4 ± 3.4) than controls (0.2 ± 0.8: Brief Pain Inventory p < 0.005), however no significant difference between groups was observed in the individually-tailored pain thresholds. Opiate using patients evidenced a significantly greater response to pain than controls in two established nodes of the “Pain Matrix”: somatosensory cortex (p FWE ≤0.001) and anterior cingulate cortex (p ≤ 0.01). This response was positively correlated with prescribed morphine equivalent dosages (average: 133.5 ± 94.8 mg/day). Conclusion: The findings suggest that in chronic pancreatitis patients, a dose of opiates that normalizes their behavioral response to acute pain is associated with an amplified neural response to acute pain. Further longitudinal studies are needed to determine if this neural sensitization hastens a behavioral tolerance to opiates or the development of an opioid use disorder.

Original languageEnglish (US)
Pages (from-to)6-13
Number of pages8
JournalDrug and alcohol dependence
Volume200
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by F31DA043330 (Dowdle), R21DA044503 (Hanlon), R25DA020537 (Back and Brady), K02 DA039229 (Back), R01DA038971 (Borckardt).The authors would like to thank the Center for Biomedical Imaging for their support.

Funding Information:
This work was supported by F31DA043330 ( Dowdle ), R21DA044503 ( Hanlon ), R25DA020537 ( Back and Brady ), K02 DA039229 ( Back ), R01DA038971 ( Borckardt ).

Publisher Copyright:
© 2019 Elsevier B.V.

Keywords

  • Hyperalgesia
  • Opioids
  • Pain
  • Prescription opiates
  • fMRI

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