Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
Ann Fam Med. 2021 Jan-Feb;19(1):79-82. doi: 10.1370/afm.2591. Epub 2020 Dec 21.
The US opioid epidemic challenges us to rethink our understanding of the function of opioids and the nature of chronic pain. We have neatly separated opioid use and abuse as well as physical and social pain in ways that may not be consistent with the most recent neuroscientific and epidemiological research. Physical injury and social rejection activate similar brain centers. Many of the patients who use opioid medications long term for the treatment of chronic pain have both physical and social pain, but these medications may produce a state of persistent opioid dependence that suppresses the endogenous opioid system that is essential for human socialization and reward processing. Recognition of the social aspects of chronic pain and opioid action can improve our treatment of chronic pain and our use of opioid medications.
美国阿片类药物泛滥危机促使我们重新思考对阿片类药物功能和慢性疼痛本质的认识。我们将阿片类药物的使用和滥用、身体疼痛和社会疼痛割裂开来，这种割裂可能与最新的神经科学和流行病学研究并不一致。身体损伤和社会排斥会激活相似的大脑中枢。许多长期使用阿片类药物治疗慢性疼痛的患者既有身体上的疼痛，也有社会上的痛苦，但这些药物可能会导致一种持续的阿片类药物依赖状态，从而抑制内源性阿片系统，而内源性阿片系统对人类的社会化和奖励处理至关重要。认识到慢性疼痛和阿片类药物作用的社会方面，可以改善我们对慢性疼痛的治疗和阿片类药物的使用。
