Summary: Overdose-related deaths are rising in the US, even as opioid use goes down. Some health experts suggest that many of these deaths are wrongly blamed on overdose. They think intractable pain is the real cause. People with intractable chronic pain are more likely to use opioids at higher doses. But pain flares may cause cardiac arrest, hypoglycemia (low blood sugar), and adrenal insufficiency, and these can kill. Such deaths may look like drug overdoses, though they are not.
Some health experts have raised the alarm. They say many deaths listed as overdoses were caused by intractable pain. People with intractable chronic pain are more likely to take opioids, and often at high doses. But some of them may die from the pain itself. Those deaths may then be wrongly blamed on overdose.
Intractable pain is a serious health problem, and yet it is still poorly understood. Millions of adults in the US live with chronic pain. Many of them do not respond to medical treatment. Pain that does not respond well to medicine is called intractable pain.
Quite often, these people live with several chronic illnesses and mood disorders. So they are also given many drugs along with opioids. Sadly, even with heavy medical treatment, drug therapy does not help them enough. They keep hurting.
Can Severe Pain Cause Cardiac Arrest?
Most people whose deaths are recorded as overdoses had sudden cardiac arrest. Cardiac arrest is hard to reverse and needs help right away. But pain flares may also lead to cardiac arrest.
Severe pain flares make the adrenal glands pump out adrenaline. That raises blood pressure and heart rate. It also pulls blood toward the center of the body. Blood vessels tighten, and less blood reaches the brain. This sharply raises the risk of heart attack, stroke, and arrhythmias (abnormal heart rhythms).
Many people with intractable pain already have a weak heart. Some opioids raise the risk of cardiac arrest even more in these people. So opioids may be a contributing factor, but not the main cause of cardiac arrest.
Can Pain Flares Cause Dangerously Low Blood Sugar?
This is one of the lesser-known things that happen when chronic pain is not managed. Insulin is the hormone the pancreas releases when you eat. It moves blood sugar into the body’s cells. Studies suggest that pain flares may also cause a sudden surge in insulin. That can cause severe hypoglycemia and even death.
Can Chronic Pain Cause Adrenal Insufficiency?
This possible problem of severe, intractable pain is also hard to diagnose.
The adrenal gland releases several hormones in response to pain and stress. These hormones are good at fighting short-term stress. But intractable chronic pain causes stress that never lets up. That may lead to adrenal insufficiency. It may also cause a significant drop in hormones like cortisol. These hormones help the body hold water and keep blood pressure up.
Studies show that almost half of those known to have died of adrenal insufficiency lived with chronic pain. There is a reason researchers have raised the alarm. They think many people with chronic or intractable pain are wrongly blamed for overdosing on drugs.
Of course, people are more likely to take higher doses during pain flares. Some even take more than the recommended dose. But that does not mean they died from a drug overdose. The drug is present, but it is not the main cause of death. When there is a chance of painkiller overdose, it is wise to seek opioid dependence treatment and prevent more problems.
These findings show why chronic pain management matters. This is true above all for intractable pain, which causes great distress. Sadly, intractable pain as the main cause of death is still a neglected subject.
The Takeaway
Painkiller overdose during chronic pain treatment can lead to addiction if it is not handled in time. The Padda Institute of Pain Management in St. Louis is known for its uniquely designed chronic pain management. Treating chronic pain at the right moment can get the results you want with the fewest problems.
Frequently asked questions
Can unbearable pain cause death?
Yes. Severe pain flares can set off cardiac arrest. They can cause a sudden surge of insulin that drops blood sugar to dangerous levels. Or they can cause adrenal insufficiency from the nonstop stress of unrelieved pain. Each of these can be fatal. The person was often taking opioids at the time. So the death may be recorded as an overdose, even when pain was the main cause.
What is intractable pain?
Intractable pain is pain that does not respond well to medicine. Many people with it live with several chronic illnesses and mood disorders at once. So they take many drugs along with opioids. Even with heavy treatment, they keep hurting. It is a serious health problem. It is still poorly understood and often ignored as a cause of death.
Why are some chronic pain deaths labeled as overdoses?
People with intractable pain are more likely to take opioids, often at high doses. During flares, some take more than the recommended amount. When they die, the drug is found and gets the blame. But a flare can stop the heart, crash blood sugar or wear out the adrenal glands. In those cases the drug is present without being the main cause.
How can people with intractable pain lower these risks?
Get the pain itself under control, early. Chronic pain management goes after the pain and the flares that set off these dangerous chain reactions. If there is a chance of taking too much pain medicine, opioid dependence treatment helps prevent more problems. Treating chronic pain at the right moment gets better results, with fewer problems, than waiting for a crisis.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
