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The Opiate Addiction Misdiagnosis: Is it Tolerance or Hyperalgesia?

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Opiate addiction causes a wide array of negative consequences and affects on both the physical and emotional well-being of a patient. However, while withdrawal symptoms such as emotional instability and social disengagement are well understood, other side effects are not as well understood. One of the misunderstood side effects of opiate addiction is hyperalgesia, which is a condition in which a patient develops a heightened sensitivity to pain due to the effects of opiates. Because patients do not recognize the risk of hyperalgesia, they typically associate pain with an increased need for opiates. This leads to a dangerous cycle where both pain and opiate use increases.

How Hyperalgesia Differs from Opiate Tolerance

Patients who use opiates, both prescribed and illegally, are at risk of developing hyperalgesia. It occurs when the opiates affect the individual’s central nervous system causing hypersensitivity. The result is that the person feels heightened pain levels even from external stimuli that would normally not cause pain. The opiates themselves do not cause pain. Instead, they simply decrease the body’s ability to categorize pain into tolerable and intolerable levels. Thus, patients who are prescribed opiates for a legitimate pain condition often associate increased pain with a worsening of the original condition.
Interestingly, many patients who suffer from hyperalgesia feel pain in a completely different area of the body than the original source. In some cases, they are unable to fully explain the feelings of pain or identify the exact location. This is one of the classic hyperalgesia symptoms and one that should raise warning flags for physicians. Patients typically required higher and higher doses of opiates to control the pain. However, instead of the pain subsiding at higher doses, it only gets worse. This is the direct opposite of what occurs with opiate tolerance, where the patients see initial pain relief from higher does, but pain returns as they grow accustomed to the higher levels.

Hyperalgesia Causes Remain a Mystery

Not all individuals who take opiates develop hyperalgesia, and the true incidence rate is unknown due to limited studies on the condition. It was once thought that hyperalgesia was related to physical dependence on opiates and that it was closely associated with withdrawal symptoms and long-term use. However, more recent studies show that hyperalgesia can occur in patients undergoing short-term treatment, some in as little as 30 days. This wide disparity of sufferers makes it difficult to pinpoint exact causal relationships between opiates and hyperalgesia.

Treatment Options For Opiate Addiction and Hyperalgesia

Standard hyperalgesia treatment options include minimizing the doses of opiates while providing optimal pain relief using other prescribed medications and non-drug therapies. Opioid rotation, where multiple opiate-based drugs are prescribed at intervals, is another option but poses addiction risks for patients who have not had proper treatment for their hyperalgesia or who have shown tendencies to overtake medication.
The staff at Waismann Drug Treatment Center are experts at assessing and treating both opiate addiction and hyperalgesia. Our medical director is quadruple board certified and is an expert in opiate treatment, detoxification and pain management. He has the knowledge and experience required to assess a patient’s addiction treatment needs to achieve a full recovery as well as minimize the chances of a relapse due to pain.



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