Predicting Addiction – How Brain Scans Could Predict Risk of Opioid Addiction for Chronic Lower Back Pain Patients

fMRI brain in pain In the near future, doctors may be better able to decide which chronic lower back pain patients can safely be prescribed opiates for pain relief. Opioid related overdoses, and problems of opioid addiction are on the rise in the US, but as chronic back pain is also increasingly common this leaves physicians in something of a quandary over appropriate treatment. Finding a way to predict who is likely to respond well to opioids, or respond well to interventions for opioid addiction, could change the way chronic back pain is treated.

New research using functional MRI scans of the brain has revealed that people with chronic lower back pain and opioid addiction have different patterns of brain activity that correspond to the severity of their disease. The new research also shows that brain changes are evident following behavioural therapy, specifically psychotherapeutic Acceptance and Commitment Therapy (ACT).

Scannning the Brain in Pain

Results of this latest study were presented at the American Academy of Pain Management (AAPM) 25th Annual Clinical Meeting by Rachel Smallwood, MS, from the University of Texas, San Antonio. Smallwood and colleagues looked at 25 patients with chronic lower back pain who were addicted to opiate painkillers and analysed the results of functional MRIs taken while the patients were at rest and when they were in pain (due to pressure being applied to their right thumbnail).

Before the patients underwent treatment, scores on a well-used assessment of disability positively correlated with activity in several brain regions. Opioid cravings also correlated with activity in several brain regions, and pain intensity was negatively correlated with activity in a number of regions of the brain.

The patients then either underwent 8 sessions of ACT or received general health education and after four weeks were once again assessed using functional MRI. Those who had the ACT treatment had altered brain activity compared to controls, with less activity seen in response to pain and altered activity when at rest. These results help increase understanding of how the brain may be affected by therapy, and which regions of the brain are linked to addiction.

Creating Tailor-Made Pain Management Programs

Understanding the loci of addictive behaviour and pain in the brain could help improve treatments offered for chronic pain from conditions like spinal stenosis, as well as for opioid addiction. This is the first time that researchers have used fMRI to assess brain activity in patients with chronic lower back pain and opioid addiction, offering valuable insights into how pain is processed in the brain and the effect of ACT on the brain, which is so far largely unknown.

As our knowledge of brain activity increases this gives physicians the potential to target pain management and tailor interventions for each patient, seeing what is and isn’t working in the brain. There could also be benefits for areas of pain management other than chronic back pain, such as neck pain, fibromyalgia, and arthritis, and any condition where there appears to be irregularities in brain connectivity, neurotransmitter function, and both central and peripheral nervous system activity.

Spinal stenosis is just one cause of chronic low back pain, with a variety of treatment options available, including surgery, non-steroidal anti-inflammatory drugs (NSAIDs), natural health products for pain relief, and also opioids. Uncovering the connections at a neural level between opioid addiction and pain could help reduce the risk of getting hooked on painkillers for chronic low back pain from spinal stenosis.


American Academy of Pain Management (AAPM) 25th Annual Clinical Meeting. Presented September 20, 2014.

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