The Ways Opioids Block Pain

 

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Pain is what has kept us alive as a species and as an individual, and as some poets and songwriters say, makes us feel alive. The former is true, but the latter is up to the person. Pain tells us to avoid things like sharp thorns or a fall that might hurt us. It protects us from harm and tells us if there’s something wrong in our bodies, like a stomach ache. Our organs can’t feel pain, but it sends signals to the surrounding muscle to induce pain, known as “referred pain.”

In some cases, the pain is too much and we’re in a situation where we need to function. People with backbone problems, slipped discs and broken bones experience excruciating pain, so much that it causes psychological conditions such as depression, irritability, and rage. We know the pain is there, but we can’t deal with it yet, or it’s being dealt with but the pain is unavoidable.

This is where Opioids and Opiates found their use. They come from a certain poppy plant whose seed-pod resin contains Opium. Ancient civilizations used this and passed it on, using its pain blocking effects for both recreational and medicinal use. As the modern times rolled by, we refined it further, making its effect more potent.

So, how does this wonder drug work? It’s a fact that billions of people from past to present have used it, but how exactly does it work?

There are two ways Opioids block pain. Direct and indirect.

How Opioids Block Pain and How They Affect the Body

The first effect is the direct one. This happens when the drug reaches the brain. It does so by going through the bloodstream and through the blood-brain barrier. The barrier is a thick clump of densely packed cells that only accept very certain substances. Since Opioids mimic endorphins, they go past the barrier and into the brain.

When they go into the brain, they specifically affect the spinal cord. The line of cells in your spinal cord is the one responsible for sending pain signals. The drug attaches to the neurons in the spine, which causes the neurons not to accept the transmitters responsible for pain. This means the spine both doesn’t receive pain signals, and won’t send them. Regardless of the pain, unless the signals are overwhelming enough to activate what little pain receptors are untouched by the opioid.

This is why dosage is important. Certain formulations like Fentanyl are powerful concentrations almost 50 times powerful than morphine, gram per gram. Depending on your condition, your doctor might give you a specific opioid. For example, if you have light pain such as post-surgery pain, or a tendon injury, your doctor can prescribe you codeine for mild to moderate pain. If you still feel pain, they may increase the dosage up, or prescribe a different kind like Oxycodone, which is more powerful than codeine gram per gram.

The second way opioids block pain rather indirect, which is the drug’s effect on the limbic system.

Your limbic system is in the very inside of your brain. This system controls your primary emotions. If you have watched Disney’s Inside Out, you may remember Joy, Anger, Disgust, Sadness, and Fear. The limbic system is what makes you feel these emotions, at first on an instinctual level.

When the drug passes the barrier and goes through your limbic system, it causes a minor effect of well being. Often, people with pain conditions do not feel this euphoria, but instead get reduced negative emotional responses to pain. This mainly affects the psychology of the user, cutting more of the edge off the pain. For recreational users, they may feel a higher sense of euphoria.

Apart from blocking pain, opioids also have the following side effects.

  • Opioids trigger the release of histamines

Histamines are the chemicals responsible for inflammation, commonly recognized during allergic reactions, where the body releases a lot of histamines. This causes dilation or widening of the blood vessels, leading to flushing of the face, chest and neck. It can also trigger mild itchiness of the skin. Some people who are sensitive to histamines sometimes get explosive itchiness.

  • Disrupts the breathing rhythm

Opioids also affect the brainstem. The brainstem manages a good majority of your involuntary muscular movements like eye blinking, heart rate, and breathing. Opioids cause a depressive effect on the brainstem, affecting breathing. It slows down the breathing rhythm, making breaths both slower and shallower. People with lung conditions are often at risk when taking in opioids.

  • Causes nausea, vomiting, and cough suppression

THis is due to the opioids’ effect on the medulla in your brainstem. The drug affects both the cough center, which suppresses the cough impulse; and your vomiting center, increasing the vomiting impulse and induces nausea. This is the reason why cough medicine one to two decades ago had trace amounts of opioids in them. According to some users, continued use of the drug reduces nausea, but still causes a significant cough suppression effect.

  • Causes constipation

Opioids inhibit gut motility or the movement of your intestines. The drug affects neurons in your small and large intestines; the same neurons that are present in your brain. It causes a depressive effect that slows or halts motility, causing constipation.

Loperamide is a kind of opioid that doesn’t cross the blood-brain barrier, allowing it to only affect the intestines. There have been cases of people taking in a large amount of loperamide in an attempt to get high. Since it does not cross the blood-brain barrier, it cannot cause any kind of euphoria and only ensures a trip to the emergency room.

  • Causes minor sedative effects

The collective effect of the minor euphoria, shallow breathing and painkilling creates a relaxing effect on the person. This relaxed state can be considered sedative but does not directly cause sleep, only aids it. Users also experience decreased sensory perception and reaction speed, giving them a “cloudy” mental state when under the influence of the painkiller.

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