July 20, 2016 – A professor at Georgetown’s School of Nursing & Health Studies (NHS) is conducting research that could help fight the American opioid addiction epidemic recently proclaimed by the Centers for Disease Control and Prevention (CDC).
Peggy Compton, interim chair of NHS’ Department of Advanced Nursing Practice, has been studying the effects of opioids for many years, including the theory that opioid use causes increased sensitivity to pain.
The professor also serves as NHS’ associate dean for research, evaluation and graduate programs.
Her previous research, published in the Journal of Pain and Symptom Management, involved patients taking methadone and buprenorphine, both opioids, for heroin addiction.
“Patients who were taking large doses of methadone, upwards of 70 milligrams, were actually less tolerant of experimental pain than people than people who were not taking any opioids at all,” Compton says of that research. “You would think that somebody taking a strong opioid like methadone would have a very high tolerance of pain, but that is not the case.”
Experimental pain is created in a research setting, using extreme cold to test subjects’ pain sensitivity. Increased sensitivity to pain is known medically as hyperalgesia.
Opioid-induced hyperalgesia has been well established in animal models, Compton says, but it is more complicated when researching the same phenomenon in humans.
“With humans, pain is a much more complex experience,” says Compton, who holds a $1.6 million grant to study the phenomenon from the National Institute of Drug Abuse. “It’s not just, 'do you feel the pain but what does the pain mean to you?' Pain is a bio-psycho-social experience.”
According to the CDC, prescription opioid pain relievers and heroin killed more than 28,000 Americans in 2014. The CDC also reports that an estimated 20 percent of patients who have acute or chronic non-cancer-related pain receive opioid prescriptions from their doctor’s or dentist’s office.
Compton says that there are currently between 3 and 5 million patients in the United States on opioids for pain treatment.
“A lot of times people are prescribed opioids as they’re leaving the dentist or leaving the hospital,” says the professor, who recently spoke in April at the National Rx Drug Abuse & Heroin Summit, which included a panel discussion with President Obama. “You’re handed a prescription and told take this when you need it and little else.”
Compton says educating the patient during the discharge process is an important role nurses can play in addressing the current opioid epidemic.
“I would like to see work done to help ensure that nurses have the knowledge to teach patients the proper use of opioids upon discharge,” she says. “I know nurses don’t mean to give inadequate discharge instructions, but I think they aren’t always trained well in how the patients should use pain medication.”
Too Many Pills
She also hopes that nurse practitioners are included in the conversation about the new CDC guidelines for prescribing opioids, as they are third in writing the most prescriptions for these medications after doctors and dentists.
"We do definitely need opioids and there are people with chronic pain who can’t get out of bed in the morning unless they take an opioid analgesic,” says Compton, who took opioids for a couple of days after recently breaking her ankle. “But you can still go to a dentist’s office and have a wisdom tooth extracted and receive a prescription for 30 pills."
“I would argue that if your pain is severe enough that you still need opioids four or five days out," she adds, "it may be an infection or another health issue and you should get back in to see a doctor.”
The CDC's new guidelines ask doctors, dentists and nurse practitioners to explore whether some of their patients could taper down to a lower dose or get off the medications.
“There is some accumulating evidence that shows that some chronic pain patients actually do better off that pain medication, that they actually improve,” Compton explains.
One of the current research projects Compton is conducting involves study subjects with prescription opioid addiction coming into a residential 30-day treatment detoxification program in which they are gradually taken off of the opioid they were using.
“We’re going to be following their cold presser pain tolerance over the course of that detoxification with the expectation that, if in fact opioid-induced hyperalgesia exists, as you take them off the opioid their ability to tolerate the experimental pain should improve,” she explains.
A cold presser is like a little ice bucket, and study subjects put their hand in it until it is so cold they have to remove it.
The professor and her research team have finished the data collection portion of the study and expect to report findings later this year.
Compton hopes the research will further the conversation about opioid-induced hyperalgesia and help address the epidemic.
“There’s a lot of literature out there, but not a lot of data,” Compton says. “I think we will probably learn that it is a good idea to take some people off opioids, a certain population. Opioids are necessary but sometimes a good Motrin can do just as well.”