Opioid-Induced Hyperalgesia (Or, Is It Really Chronic Pain?)

opioid-induced hyperalgesia

Medical professionals define chronic pain as pain that lasts six months or more, with little prospect for total relief. The pain may be “achy” or severe, constant or intermittent. It can be due to nerve damage, physical injury, or the accumulated effects of excessive muscle use, poor posture, and/or osteoporosis. Unfortunately, chronic pain also tends to trigger emotional stress and physical tension, which only increase discomfort. Many cases of “chronic pain,” though, are actually cases of what doctors call hyperalgesia.

What Is Hyperalgesia?

Hyperalgesia” means hyper-sensitivity to pain: unlike most forms of chronic pain, it isn’t directly caused by physical trauma or deterioration. What changes is the way the sufferer perceives pain: nerves register “agony” signals for pinpricks and other things that normally cause only minor discomfort. (A closely related syndrome is allodynia, which triggers severe-discomfort perceptions in response to normally innocuous sensations.)

Hyperalgesia can be primary (localized in one part of the body) or secondary (affecting a larger area, often spreading out from a primary-hyperalgesia location). Frequent causes include nerve-damaging injury, tissue inflammation, autoimmune disorder—and use of opioid medications.

When Hyperalgesia Is Due to Opioid Use

It’s well known that careless prescription of opioids—mostly for chronic pain—triggered an addiction epidemic around the turn of the twenty-first century. What’s gotten less attention is that even without addiction, ongoing use of opioids invites hyperalgesia—chronic pain’s lookalike cousin—to take up residence.

The reason lies in the brain’s natural programming to repair or compensate for injury to the body. Normally, this is a positive thing: it’s what enables stroke patients to regain muscle function, and what teaches people to make maximum use of their remaining senses after losing sight or hearing. But when someone has taken pain medications for an extended period—effectively shutting off the transmission of pain signals—the brain control center may decide that the transmission system needs help, and may charge up alternate pain-sensation pathways. The result: opioid-induced hyperalgesia (OIH).

If you’ve been taking an opioid prescription for a while, and now the pain is back and getting worse; if the pain seems to be spreading beyond its original site; if you feel disproportionately severe pain at the slightest scratch; and especially if your “chronic pain” seems at its worst after you take your pain medication—hyperalgesia may be the cause.

Hyperalgesia and Opioid Abuse

Opioid-induced hyperalgesia is different from addiction to or tolerance of a drug. Tolerance means that more of a drug is required to achieve the same pain-relief effect; OIH means that increasing the dose increases the pain perception. Unfortunately, not all doctors are aware of the OIH effect, and many respond to complaints of new pain by prescribing larger doses ofopioids. Even worse, many patients increase doses on their own initiative; and, since their actual tolerance level hasn’t changed, extra medication means extra risk of overdose.

Of course, upping opioid intake is risky even if increased pain is due to increased tolerance: in that case, taking more opioids may seem to “work,” only to start a slide toward addiction. In the worst-case scenario, OIH and addiction co-occur, perhaps to the point that a sufferer begins taking especially heavy doses, seeking total unconsciousness as the last escape from ever-increasing pain.

What to Do

If you suspect that you or a family member have opioid-induced hyperalgesia, see your prescribing doctor. When scheduling the appointment, make clear that you need time to talk specifically about hyperalgesia and to thoroughly evaluate not only your current prescription, but the possibility of tapering off opioids completely (a good idea anyway, if you’ve been taking them for any length of time) and finding an alternate means of pain management.

Be prepared also to tell your doctor about possible signs of opioid addiction: frequent drowsiness, craving the drug even when it increases your pain, neglecting responsibilities/budget/grooming to keep up with opioid doses. If you have an addiction (with or without OIH), complete recovery requires supervised detox and professional counseling from addiction-medicine specialists.

In any case, anyone suffering ongoing pain can benefit from non-drug approaches to relief:

  • Deep breathing
  • Focused relaxation
  • Yoga stretches
  • Chiropractic treatment
  • Therapeutic massage
  • Reducing overall stress and worry through positive thinking, regular rest, and absorbing activities

Since all of these work with your physical system rather than putting foreign substances into it, the brain doesn’t respond by turning up pain sensitivity. And unlike drug use, the habits formed by non-chemical pain relief approaches have almost entirely positive effects!

Treatment for Pain and Opioid Problems in Hemet, California

Since opioid addiction often begins with chronic-pain medication, Hemet Valley Recovery services include a specialized Chronic Pain and Addiction Treatment Program to help clients recover from addiction and learn to manage pain without narcotic analgesics. Whether your own pain problem is due to genuine chronic pain or to hyperalgesia, if it co-occurs with addiction we can help you find relief. Contact us for a consultation.