A Precision Medicine Approach to Non-Cancer Chronic Pain Co-Occurring with Stress
Recommending a multi-disciplinary, patient-centered approach to avoid opioid misuse and over-prescription.
In a review article published in Frontiers in Psychiatry in May 2016, Udi Ghitza, PhD of the NIH aimed to identify mechanisms common to chronic non-cancer pain and stress-induced relapse of opioid misuse in recent research studies.1 The author sought to determine knowledge gaps and propose ways to address them using adequately designed randomized-controlled trials. These steps would help better shape clinical care of patients experiencing both pain and stress symptoms.
The author argued that poor understanding of neurobiological mechanisms common to non-cancer chronic pain, stress, and stress-induced opioid misuse relapse, combined with a lack of treatments specific to certain types of pain were to blame for opioid over-prescription. Current care for chronic non-cancer pain management seldom uses a mutli-disciplinary, collaborative and patient-centered approach, which the author argues would be more successful in addressing underlying etiologies and pain-stress comorbidities.
The author identified extensive overlap between mechanisms underlying pain-related psychological behaviors and those underlying stress-related opioid overuse. A precision medicine type of approach to chronic non-cancer pain and opioid misuse is necessary, according to Dr Ghitza. It should combine patient-centered care and multi-disciplinary involvement, including assessment of psychiatric comorbidities. Such modifications in pain management care would be useful in designing pain self-management paradigms.
Another aspect of this precision medicine approach that Dr Ghitza recommends is assessment of preferred treatment options and of factors impeding recovery in individual patients, both contributing to positive behaviors and overall well-being, as well as improved clinical practice.
1. Ghitza UE. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain: Clinical Implications. Front Psychiatry. 2016;7:80.