August 23, 2017

The Pain of Addiction – Opioid Induced Tolerance and Hyperalgesia

[frame align=”right”]Opioid Induced Hyperalgesia[/frame]Objectives:

  1. Understanding that chronic pain is physiologically different from acute pain
  2. Understanding how chronic use of opiates can cause pain and offer ways to treat pain without opiates
  3. Understand how chronic pain can promote a chronic dependency

Opioid-Induced Hyperalgesia (OIH) is a clinical phenomenon, characterized and measured by increasing pain in patients that are receiving repeated doses of opioids. It has been recognized that opioids can activate a pronociceptive mechanism resulting in increased pain sensitivity. Although opiates are the cornerstone medications for treatment of pain, evidence suggests that pain patients on opiate medications, or chronic opioid therapy, become more sensitive to pain (hyperalgesia) over time. Generally, patients become more sensitive to pain when use is extended for over three months. The opioid use over long periods increases the body and brains pain signal. Measuring patient pain is complex, relying on the patients self-report of pain scores makes it more difficult to distinguish OIH from other pain. OIH occurs through distinct cellular mechanism, endogenous, dynorphin, the glutamaterigic system, and descending facilitation. Cellular mechanism of OIH similar with those of neuropathic pain and opioid tolerance

[pullquote align=”left”]”everything hurts”[/pullquote]

The common remark from patients is “everything hurts” is a classic patient complaint of OIH. Patients begin taking medications to manage physical pain, then a shift occurs, often times without the realization of the patient, they begin using the medication to manage emotional pain as well. In the end, the patient is taking so many medications that their quality of life is reduced to a state of despair, suffering and pain. Patients seeking treatment for OIH simply say “I want my life back”. Pain recovery is possible without addicting medications. Some of the keys are to find a balance in life, explore alternative pain management strategies, begin to think about pain differently, and commit to a treatment program that will help provide freedom from habit-forming (addictive) substances. Medical detoxification in the hospital setting using standardized detoxification protocols facilitates recovery while the nervous system recalibrates in the absence of opioids.

Download a PDF on Opiate Induced Hyperalgesia