Summary: Overdose-related deaths are rising in the US, despite the declining use of opioids. Some health experts have suggested that many deaths are wrongly attributed to overdose, though they are due to intractable pain. People living with intractable chronic pain are more likely to use opioids at higher dosages. However, pain flares may cause cardiac arrest, hypoglycemia, and adrenal deficiency, causing death. Such deaths may look due to drug overdose, though they are not.
Some health experts have raised the alarm that many deaths registered as due to overdose were caused by intractable pain. People living with intractable chronic pain are more likely to be taking opioids, and often at high dosages. However, some of them may die due to intractable pain, but such deaths may be wrongly attributed to overdose.
Intractable pain is a severe health issue, and yet it remains poorly understood. There are millions of adults living with chronic pain in the US. However, many of these people living with chronic pain do not respond to medical treatment. A pain that does not respond well to medications is called intractable pain.
Quite often, these people are living with multiple chronic ailments and mood disorders. Thus, they are also given numerous medications along with opioids. Unfortunately, despite extensive medical treatment, they fail to benefit sufficiently from drug therapy and continue to experience pain.
Most people who are diagnosed to have died due to overdose are those who have experienced sudden cardiac arrest. Cardiac arrest is quite challenging to reverse and requires urgent help. However, it is worth understanding that pain flares may also lead to cardiac arrest.
Severe pain flares cause adrenal glands to pump adrenaline and raise blood pressure and heart rate. Additionally, it causes centralization of blood, causing a low blood supply to the brain and vasoconstriction. This considerably increases the risk of heart attack, stroke, and arrhythmias.
Many of those living with intractable pain already have a weak heart. Some opioids only increase the risk of heart arrest in such individuals. Thus, opioids may be regarded as a contributing factor but not the prime cause of cardiac arrest.
It is among the lesser-known phenomena that occurs in those living without chronic pain management. Insulin is the hormone released by the pancreas in response to food intake. It promotes the movement of blood glucose to various body cells. Studies suggest that pain flares may also cause a sudden upsurge in insulin levels causing severe hypoglycemia and even death.
Again, one of the possible complications of severe, intractable pain is also among the conditions that are difficult to diagnose.
The adrenal gland secretes multiple hormones in response to pain and stress. These hormones are good at countering acute stress. However, intractable chronic pain causes continuous stress, which may lead to adrenal insufficiency. In addition, it may result in a significant decline in hormones like cortisol. Such hormones play an important role in water retention and blood pressure.
Studies show that almost half of those known to have died due to adrenal insufficiency were living with chronic pain. There is a reason why researchers have raised the alarm. They think that many of those living with chronic or intractable pain are wrongly blamed for overdosing on drugs.
Of course, people are more likely to take medications at higher dosages and sometimes even exceed the recommended dosage during pain flares. However, it does not mean these people have died from a drug overdose. Needless to say that drug overdose is present in such instances, but it is not the prime cause of their death. In such cases, where there are chances of painkiller overdose, it is advisable to go for opioid dependence treatment and prevent any further complications.
These findings show the importance of chronic pain management or intractable pain management, which causes significant distress. But, unfortunately, intractable pain as the prime cause of death remains a neglected subject.
The painkiller overdose during chronic pain management and treatment can lead to addiction if not taken care of timely. The Padda Institute of Pain Management in St Louis is known for its uniquely designed chronic pain management. Hence, addressing the chronic pain at the right moment can help achieve the desired results with minimum complexities.
By Gurpreet Singh Padda, MD, MBA