Tapering off long term opioid use is difficult for nearly everyone. There can be a variety of symptoms, none of which are pleasant. While many people display physical symptoms, the majority of injured workers suffer from psychological ramifications such as depression, anger and anxiety. Thankfully, there are simple strategies to employ that will go a long way in helping these injured workers recover over time.
The science behind moods and opioids
Once you understand what happens to the mind and body on opioids, it’s easy to see why many people experience depression and other negative emotions while tapering off. The chemical structure of opioids mimics that of a natural neurotransmitter. The drugs attach to and activate receptors in the brain that are largely responsible for the way we feel. Dopamine, the ‘feel good’ neurotransmitter is produced naturally in the brain and acts as a mood regulator, helping to control its reward and pleasure centers. When opioids are introduced, the drugs themselves target the brain’s reward system and flood the circuit with neurotransmitters, including dopamine. Another neurotransmitter affected by the opioids is serotonin, which regulates sleep and appetite. The brain is essentially getting an overload of these neurotransmitters from the opioids. In response, it stops producing them on its own. While the person is taking opioids, he feels psychologically fine — even euphoric. But tapering off the opioids ends the artificial influx of the neurotransmitters and it takes the brain some time to produce them again on its own. While the brain is repairing itself, there are few natural neurotransmitters to regulate mood, and the injured worker may be overwhelmed with feelings of doom and gloom. This is experienced by about two-thirds of the injured workers we treat.
What to do
The good news is that there are many ways we can actually jump-start the brain’s production of dopamine and serotonin. Cognitive behavioral therapy (CBT) is among the best, as it helps injured workers change their thoughts and behaviors, which helps activate these neurotransmitters.
Several strategies used in conjunction with CBT trigger the production of these mood-regulating chemicals:
- Exercise releases endorphins in the body. These molecules resemble opioids in the way they are structured and help to minimize and control pain. The more vigorous the exercise, the greater the release of endorphins all the way up the cascade to production of anandamide, a cannabinoid our brain can produce (the word Ananda in Sanskrit means, “bliss”). Injured workers should do weight training with high and low-intensity exercises to the best of their abilities.
- Meditation produces optimum levels of serotonin and endorphins and is one of the best solutions for jumpstarting the brain’s ability to activate these neurotransmitters.
- Setting and achieving goals releases dopamine in the brain. Goals that are challenging yet doable distract the injured worker from his chronic pain. Setting goals exercises the problem-solving center of the brain that has become underutilized on opioids.
- Music can improve the injured worker’s mood and trigger the “good feeling” brain chemicals dopamine and serotonin.
- Pleasant aromas go right to the limbic (emotional) area of the brain and can reduce depression, anxiety and anger.
- Laughter can help activate dopamine, serotonin and other naturally occurring neurotransmitters. Laughter therapy involves nonsensical laughing, without hearing a joke. Simply forcing a smile, then forcing a small laugh can trigger full, authentic belly laughing.
Injured workers who suffer from depression, anxiety and other unpleasant emotions while tapering off opioids can benefit from activities that stimulate production of neurotransmitters in the brain. Doing so will shorten the time they have these symptoms so they can feel better faster.
IMCS is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.