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Opioid-Induced Hyperalgesia (OIH)

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What is Opioid-Induced Hyperalgesia (OIH)?

Have you taken opiate painkillers only to find that your pain has gotten worse?
Hyperalgesia is a condition that manifests itself by an increased sensitivity to pain. Opioid-induced hyperalgesia occurs when the continuous use of opioids reduces the pain threshold, leading to opioid tolerance. In other words, pain becomes worse despite an increase in dose or escalation of use.

Hyperalgesia occurs as a result of changes to the nerve pathways. Although this condition is often a consequence of opioid use disorder, there can be many other potential causes. This paradox poses a challenge for doctors, therapists, and other health care professionals trying to help patients manage pain effectively. It’s often hard for people to wrap their heads around the idea that medication intended to relieve pain has the opposite effect.

 Some Important Hyperalgesia Facts:

  • Hyperalgesia is a medical condition.
  • A condition caused by changes to the nerve pathways
  • Often a result of continuous opioid intake.
  • It creates a hypersensitivity to pain.
  • A condition that goes undiagnosed way too often
  • In some instances, it leads to opioid tolerance and addiction

Symptoms of Hyperalgesia

The main symptom of hyperalgesia is an extreme response to pain stimuli. Scientists believe that this is a direct consequence of miscommunication of the pain pathways. In other words, the nervous system is disrupted and not able to transmit pain signals accurately. The condition is difficult to diagnose, and when opioids are part of the treatment, it is often confused as drug tolerance.

Treating Chronic Pain

Chronic pain conditions are widespread and provide quite a challenge for the medical community. Opioids such as hydrocodone, oxycodone, and morphine are often the drugs of choice for doctors and specialists treating severe acute and chronic pain resulting from some conditions. The use of these narcotic pain relievers can produce hyperalgesia or opioid-induced pain sensitivity. The continuous use of this class of medication can also lead to opioid tolerance.

Tolerance occurs when the body becomes accustomed to the drug and no longer responds to its intended effects. Traditionally, studies explained the decrease in analgesic effectiveness by developing tolerance or progression of the condition. Doctors are now coming to understand that this opioid-induced pain sensitivity can cause increased pain. In the case of OIH, it might make sense to increase the dosage to combat the pain, but the opposite is thought to be true. Tapering the dose may also work to reduce pain.

Opioid Effects on Pain Perception

Opioid medication reduces pain by attaching to opioid receptors, which decreases the number of pain messages sent to the brain. However, opioid drugs can also produce an opposite reaction to the nervous system. It can increase pain symptoms due to a hyperactivation of the nervous system leading to hyperalgesia. Although this is a more common phenomenon to patients on higher doses or more extended periods of daily opioid intake, it can certainly happen after just a few doses.

Some genetic factors have also been shown to leave specific individuals more prone to opioid-induced hyperalgesia. It is essential to recognize the signs of opioid-induced hyperalgesia, such as: 

  • Increase sensitivity to areas of the body beyond the site of injury.
  • The constant progression of pain intensity, regardless of the underlying cause.
  • The pain area extends beyond the area from the original injury, with no apparent reason.
  • New pain may appear without a specific diagnosis.
  • Long-lasting, decentralized, and challenging to define pain.
  • Simple stimulations that cause no pain before may suddenly become painful.

Treating Opioid-Induced Hyperalgesia

Pain from OIH can be debilitating. Increasing the dose of opioid medications is very dangerous and often unproductive in these cases. Once OIH is diagnosed, treatment options can include a reduction in dosage, a rotating schedule for use, or the introduction of adjunct medications. Although this might be a good option, it does not always work. Patients are often left suffering from opioid withdrawal or the level of pain caused by the hyperalgesia. For those reasons, doctors need to be knowledgeable, compassionate, and, most of all, responsible. They need to listen to patients’ fears, abilities, and symptoms.

A successful approach to combat Opioid-Induced Hyperalgesia has been medically assisted opioid detoxification. Withdrawal symptoms are controlled and reduced in an accredited hospital. Patients can overcome withdrawal and reverse tolerance and dependence comfortably and effectively. Once there is no opioid use disorder, the nervous system will start regulating, and the pain sensitivity reduced.

At that time, patients with persisting pain due to various ailments can explore non-narcotic pain therapies or alternative pain management practices.

If you or a loved one is currently suffering from Opioid-Induced Hyperalgesia, give us a call today. Let’s discuss the best available treatment options and what the Waismann Method® can offer. Our quadruple board-certified medical director, Michael H. Lowenstein M.D., is a specialist in Opioid Use Disorder and pain management. Having these two certifications allows Dr. Lowenstein to understand, assess, and treat you.

Don’t suffer another day. Call us now 1-800-423-2482

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