Study: Behavioral Therapies Work Better Than Opioids in Managing Pain of Mentally Ill

st people with a mental illness would be lost without their day-to-day medications. Whether it is an antipsychotic drug, a tranquilizer or an antidepressant, the symptoms of most mental illnesses are managed with medications. Apart from the psychological impediments that arise when regions in the brain associated with memory, speech and emotions fail to function in sync or when the neurotransmitters go haywire, most people living with a mental disorder also experience pain on a regular basis.

A recent research highlights that opioid prescriptions are discharged in alarming numbers to those suffering from mental disorders. The researchers suggest that improving pain management for people with mental health problems “is critical to reduce national dependency on opioids.” According to the study titled “Prescription Opioid Use among Adults with Mental Health Disorders in the United States,” adults with some form of mental ailment are receiving more than 50 percent of the 115 million opioid prescriptions given on an annual basis in the United States.

The study findings, published in the Journal of the American Board of Family Medicine, also revealed the startling fact that while nearly 19 percent of Americans with a mental health ailment were habituated to prescription painkillers, only 5 percent of those without any mental health condition were on opioids. The study used the nationally representative Medical Expenditure Panel Survey (MEPS) to examine the relationship mental health ailments, especially anxiety and depression, and prescription opioid use.

Pain is often misunderstood and overprescribed

The nature of pain is not yet understood. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience, associated with actual or threatened tissue damage, or described in terms of such damage.” In the absence of objective tools to diagnose mental disorders, most physicians have to rely on their own experience and interpretation of an illness as well as patient’s self-reported symptoms.

While talking about this anomaly in the sensory perception of pain, especially with respect to those living with poor mental health, Dr. Brian Sites, an anesthesiologist at Dartmouth-Hitchcock Medical Center in New Hampshire and one of the study researchers, says, “Since (pain is) a subjective phenomenon, it’s very difficult to measure those things and treat them because some patients (report) 10-out-of-10 pain forever.”

The researchers expected that physicians would practice discretion. But unfortunately most physicians are quite liberal in prescribing opioid medications to the mentally ill. According to Dr. Sites, this is resulting in significant morbidity.

As per Dr. Edwin Salsitz, an attending physician in the division of chemical dependency of Mount Sinai Beth Israel Medical Center in New York, though opioids are primary treatment for pain, mentally ill patients start believing that the drugs alleviate their mental issues. This pushes them into a vicious cycle of addiction and abuse.

Dr. Andrew Saxon, director of the addiction psychiatry residency program at the University of Washington, is of the opinion that in most instances drugs neither provide lasting relief nor improve everyday functioning. They just provide a subjective gratification of reduced pain. The situation gets grim as those addicted to opioids to treat pain develop a co-occurring mental disorder, which further deteriorates their overall health.

Road to recovery

Saxon, who is also the chairman of the American Psychiatric Association’s council on addiction, gives more importance to behavioral interventions and alternate therapies rather than being dependent on opioids. He also suggests that teaching people to understand the root cause of the problem and develop coping skills is more effective in the long run. The study serves as a reminder that it is important to empathize with the person living with a mental health condition instead of washing hands of by prescribing medications. The aim should be to improve patients’ overall quality of life rather than putting them at further risk.