What Should You Do if Experiencing Opioid-Induced Hyperalgesia?

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Opioid medications are primarily used as strong painkillers. They have been traditionally used to treat severe, acute pain. However over the last few decades, many patients have started on them for chronic pain.

Nowadays, now that we have studied the effects of opioids for long term chronic pain, we have come to learn that they have serious side effects long term, including the development of a phenomenon called “opioid induced hyperalgesia”, wherein the individual actually gets overly sensitive to pain while on opioids, making their pain worse instead of better.

For these reasons, essentially all authoritative bodies on addiction and chronic pain recommend against the use of opioids for long term pain management, with a few exceptions including chronic cancer related pain. 

How Do Opioids Impact Your Brain’s Response to Pain?

Opioids attach to receptors on cells in your brain, and once latched, they induce chemical reactions that block pain signals. This is how they work, at least initially, to decrease pain.

Over days, weeks and months, your cells respond to this constant stimulation by increasing the number of opioid receptors they express. When those receptors sit un-occupied, they produce additional pain signals, leading to an actual worsening, not bettering, of pain over time. This is called opioid induced hyperalgesia. It often means that patients need higher doses of these medications just to get the same pain relief that they did previously, leading to increased risks of sedation, respiratory depression and sudden death.

Some experts think hyperalgesia is behind the opioid epidemic.[1] Some people take more painkillers to address their worsening pain, not realizing that they’re potentially contributing to the pain cycle and making the problem worse over time. 

Common Hyperalgesia Symptoms

People with opioid-induced hyperalgesia (OIH) are in a significant amount of pain. Their bodies are amplifying signals that others might ignore.

Some people have worse pain when their doctors increase their painkiller dose.[2] Others have new sources of pain in response to things that never bothered them before. 

Treatment for Hyperalgesia 

If you think you are experiencing opioid-induced hyperalgesia, you should do the following:

  • Ask an expert. Seek a pain evaluation, ideally from a multidisciplinary treatment team of providers.
  • Try other medications. First-line treatments include non-opioid analgesics (acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen) and adjunctive medications, such as antidepressants and anticonvulsants.
  • Use non-pharmaceutical therapies. Exercise, physical therapy, cognitive behavioral therapy (CBT), and complementary and alternative medicine (like chiropractic therapy, massage therapy, acupuncture, mind-body therapies, and relaxation strategies) may provide pain relief.

The good news is that opioid induced hyperalgesia can and will resolve over time with discontinuation of opioids. [3] This process of slowly discontinuing opioids can take weeks or months, but eventually your body’s opioid receptors will normalize, and many patients will actually experience a significant improvement in their pain after discontinuing chronic opioid use.

If you think your pain is poorly controlled with chronic opioids and that you may be experiencing opioid-induced hyperalgesia, reach out to your doctor. They can help you come up with an effective strategy to reduce and/or eventually discontinue chronic opioid therapy and help find other, more evidence based strategies for addressing your chronic pain.

Sources

  1. Why Painkillers Sometimes Make the Pain Worse. Science. https://www.science.org/content/article/why-painkillers-sometimes-make-pain-worse. November 2016. Accessed July 2022.
  2. Opioid-Induced Hyperalgesia: When Painkillers Make Pain Worse. BMJ Case Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054124/. June 2014. Accessed July 2022.
  3. When Medications Make Pain Worse: Opioid-Induced Hyperalgesia. The Consultant Pharmacist. https://pubmed.ncbi.nlm.nih.gov/21840817/. August 2011. Accessed July 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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