High dose intake of opioid is not effective in reducing pain

A recent study has established that high dose intake of opioid is not effective in reducing pain.
The researchers' team from Central Arkansas and Minneapolis VA Health Care Systems and three universities have suggested after studying available data that patients who got their opioid dosage increased were not helped by the higher dosage as compared to those, who continued with earlier dosage.

The Veterans Affairs study looked at prescribing data of more than 50,000 VA patients taking opioids. The findings led the study authors to warn: "Clinicians should exercise extreme caution when embarking on a path of increasing opioid doses to manage non-cancer pain."

The results were published in the January 9 issue of the journal 'Pain'.

A companion study by the same team that appeared online on January 15, in addition, confirmed the increased risk of side effects from higher doses.

Lead author Dr Corey Hayes in a University of Arkansas for Medical Sciences report said: "You don't see the benefit, but you do see the risk. Our overall message is when you're thinking about increasing the dose, you need to realize the risk it brings, too."

Opioid medications relieve pain. They reduce the intensity of pain signals in the brain and affect areas of the brain controlling emotion, which diminishes the effects of pain stimuli. While opioids can help manage pain when taken correctly, they have a high risk of abuse and addiction.

Patients often receive increased doses of opioid medication because their pain may not be well-controlled on lower doses. People can also develop a tolerance to opioids over time, meaning a higher dose is needed to get the same effects. In these cases, prescribers must weigh the risks and rewards of escalating a patient's opioid dose.

Moreover, higher opioid doses can lead to a variety of side effects, such as constipation, dizziness, increased sensitivity to pain, and increased risk of substance use disorder. 

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Heavy drinking during youth can disrupt brain development

Excessive alcohol use during adolescence can disrupt the development of brain and increase risk of substance use disorder later in life, a study says.

“The maturation of the brain is still ongoing in adolescence, and especially the frontal areas and the cingulate cortex develop until the twenties. Our findings strongly indicate that heavy alcohol use may disrupt this maturation process,” said first author of the study Noora Heikkinen from University of Eastern Finland.

Cingulate cortex has an important role in impulse control, and volumetric changes in this area may play an important role in the development of a substance use disorder later in life.

The study — published in the journal Addiction — performed magnetic resonance imaging (MRI) of the brain structure on young and healthy, but heavy-drinking adults who had been heavy drinkers throughout their adolescence, as well as on age-matched light-drinking control participants. 

They participated in three cross-sectional studies conducted over the course of ten years, in 2005, 2010 and 2015. The participants were 13 to 18 years old at the onset of the study.

All participants were academically successful, and the prevalence of mental health problems did not differ between the two groups.
Although the heavy-drinking participants had used alcohol regularly for ten years, approximately six-nine units roughly once a week, none of them had a diagnosed alcohol use disorder.

MRI of the brain revealed statistically significant differences between the groups. 

Among the heavy-drinking participants, grey matter volume was decreased in the anterior cingulate cortex bilaterally as well as in the right insula.

While cingulate cortex has an important role in impulse control, structural changes in the insula, on the other hand, may reflect a reduced sensitivity to alcohol’s negative subjective effects, and in this way contribute to the development of a substance use disorder.

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