Living With Chronic Pain

How Endorphins Help Pain, Boost Mood

Previously I discussed opioid receptors in the body, what they do and how they are activated. For decades, scientists have been trying to unlock the bodies natural, self produced analgesics without prescribing pharmaceuticals that have devastating side effects or requiring high intensity, prolonged exercise, impossible for chronic pain suffers to achieve.

A promising new study has been investigating ways to enhance the Mu receptors using positive allosteric modulators (PAMs) to enhance what we already produce. Because they don’t activate the Mu receptor directly, but instead enhance endogenous peptides to relieve pain, they allow them to last longer with less side effects than currently used narcotics cause. Research is also looking for a more targeted medication that gives pain relief without globally activating receptors in the GI tract, lungs, skin, etc. As exciting as this and other research is, it’s still far too early to have an impact on chronic pain sufferers now. So the best opinion is to learn how to enhance our own bodies amazing pain relief system.

Any activity that raises the heart rate for an extended period of time triggers our internal analgesic system. But that begs the question- how can we engage in the necessary high intensity exercise for the 10-30 minutes required if we are in so much pain? The good news? Any activity that increases your heart rate will work, even a 20 minute fast walk in the neighborhood.

The goal is to get the central nervous system and pituitary gland to release endorphins- our own feel-good hormones. In life threatening situations they allowed us to push through the pain and continue whatever physical exertion was required to survive. They energize and catapult us to perform better and longer if the threat is ongoing. We have since learned they also aid athletes running a marathon or on the playing field to achieving greater heights.

Endorphins are critical to how we manage pain and experience pleasure. They are released when we are:

  • injured
  • feel stressed or anxious e
  • eating
  • exercising
  • sexual encounters also activate our natural reward system

I’m often asked what endorphins feel like. My answer? You will know when it happens.  I first experienced a “runners high,” jogging 2-3 miles a day. Initially outdoors, it was boosted by the magnificent skies and landscape. Moving indoors to a treadmill dampened it slightly. Now it takes longer to achieve on my elliptical. But by 10-15 minutes I am definitely in the “zone.” My body is finally working as a unit. The blood is surging to every muscle group, my brain shuts out all the stressors from the day as it focuses solely on keeping my body moving and my breathing is deep and strong, pushing rejuvenating oxygen throughout. A sense of well being, calm, and strange as it sounds-less pain.

A few examples of how endorphins can benefit the body:

  • They decrease fatigue, in some, altogether. Chronic pain is exhausting. It may sound crazy to encourage strenuous activity and other options that release endorphins as a treatment, but it has actually been shown to improve fatigue. 
  • In many studies pain relief was almost immediate. For me, it I often have to push through my initial discomfort when I start my stretches/ elliptical program for at least 10 minutes before I feel the effects. Athletes state its an endorphin kick that often helps them get past the times they struggle in the middle or end of their competition.
  • Mood elevation and a feeling of euphoria are amazing benefits. That’s why exogenous opioids such as oxycodone and morphine are so additive. That “runners high” is significantly boosted because exogenous opioids activate the entire opioid receptor system, and have a prolonged effect. This is the opposite of endogenous opioids, which have a targeted effect on specific receptors.

Endorphins may not have long lasting effects, but a regular workout program of 150 minutes of exercise a week, with 75 of those being a more vigorous aerobic activity, increases its impact.

What’s more, the hippocampus – the part of the brain associated with memory and learning -has actually been shown to increases in volume in the brains of regular exercisers. Those that exercise regularly also exhibit:

  • Improved working memory and focus. This occurs by stimulating physiological changes such as decreased inflammation and insulin resistance that negatively impact our thinking. It also increases production of growth factors that not only create new blood vessels but increase, enhance and improve the overall health of newly created brain cells.
  • Better task-switching ability. Slower, more focused exercises like Tai Chi appear to improve executive functions that manage planning, memory, attention, problem solving and verbal reasoning.
  • Reduce stress and anxiety by improving mood and sleep, which often contribute to cognitive impairment.

Next week I’ll discuss ways we can increase the release of our own endorphins as a way to diminish pain and improve overall mental and physical health.



https://www.health.harvard.edu/staying-healthy/exercising-to-relax

https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-truth-behind-runners-high-and-other-mental-benefits-of-running

https://www.health.harvard.edu/mind-and-mood/exercise-can-boost-your-memory-and-thinking-skills

https://www.nih.gov/news-events/nih-research-matters/brain-imaging-reveals-joys-giving

https://www.sciencedaily.com/releases/2017/06/170601124121.htm

https://www.medicalnewstoday.com/articles/320839#low-endorphins-and-health-conditions

https://www.ucsf.edu/news/2018/05/410376/bodys-natural-opioids-affect-brain-cells-much-differently-morphine

https://www.nyu.edu/about/news-publications/news/2020/june/delta-opioid-receptor-pnas.html

https://n.neurology.org/content/79/8/807.abstract

https://www.reuters.com/article/us-pain-receptors-cells/opioid-receptors-inside-cells-important-for-pain-relief-idUSKBN23T22F

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