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DiscussionReflections

When Physical and Social Pain Coexist: Insights Into Opioid Therapy

Mark D. Sullivan and Jane C. Ballantyne
The Annals of Family Medicine December 2020, DOI: https://doi.org/10.1370/afm.2591
Mark D. Sullivan
1Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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  • For correspondence: sullimar@uw.edu
Jane C. Ballantyne
2Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Abstract

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.

Key words
  • endogenous opioid system
  • social rejection
  • reward
  • opioid dependence
  • addiction
  • Received for publication December 4, 2019.
  • Revision received February 14, 2020.
  • Accepted for publication March 10, 2020.
  • © 2021 Annals of Family Medicine, Inc.
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When Physical and Social Pain Coexist: Insights Into Opioid Therapy
Mark D. Sullivan, Jane C. Ballantyne
The Annals of Family Medicine Dec 2020, DOI: 10.1370/afm.2591

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When Physical and Social Pain Coexist: Insights Into Opioid Therapy
Mark D. Sullivan, Jane C. Ballantyne
The Annals of Family Medicine Dec 2020, DOI: 10.1370/afm.2591
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Subjects

  • Domains of illness & health:
    • Chronic illness
    • Mental health
    • Disease pathophysiology / etiology
  • Other topics:
    • Social / cultural context

Keywords

  • endogenous opioid system
  • social rejection
  • reward
  • opioid dependence
  • addiction

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