New research from The University of Manchester has shown for the first time that the number of opiate receptors in the brain increases to combat severe pain in arthritis sufferers. By applying heat to the skin using a laser stimulator, Christopher Brown, Ph.D. and his colleagues showed that the more opiate receptors there are in the brain, the higher the ability to withstand the pain.
Opiates Receptors Increase to Battle Arthritis

Dr. Brown said in the October 23, 2015 news release, “As far as we are aware, this is the first time that these changes have been associated with increased resilience to pain and shown to be adaptive. Although the mechanisms of these adaptive changes are unknown, if we can understand how we can enhance them, we may find ways of naturally increasing resilience to pain without the side effects associated with many pain killing drugs.”
As indicated in the news release, “The study used Positron Emission Tomography (PET) imaging on 17 patients with arthritis and nine healthy controls to show the spread of the opioid receptors. This suggests that the increase in opiate receptors in the brain is an adaptive response to chronic pain, allowing people to deal with it more easily.”
Professor of Cognitive Neuroscience at the University, Wael El-Deredy said, “Receptor imaging is challenging and requires the co-ordination of a large team to collect and analyse the images. We are very lucky to have this technique in Manchester. There are very few places in the world where this study could have been done.”
Dr. Brown told OTW, “There was already evidence from animal studies that opioid receptor upregulation may occur in response to chronic pain, and we helped confirm this in people with arthritis. However, it was a surprise that this upregulation would have a relationship to pain threshold, and this has led to us speculating that opioid receptor upregulation may be an adaptive response to chronic pain that helps sufferers cope with it more easily.”
“It is important for any clinician treating chronic pain patients to understand that brain neurochemistry has an effect on the amount of pain the patient feels, and that this neurochemistry can be altered with experience. This may help explain why some patients recover better than others after arthroplasty.”
Asked about future research, Dr. Brown noted, “We are interested in whether brain neurochemistry can be altered for the better with lifestyle changes such as exercise and relaxation, or through psychological interventions. If so, we might be able to improve outcomes from many types of treatment including pharmaceutical and surgical treatments.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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