Tag Archives: hyperalgesia

Misconceptions about Opioid Abuse in Chronic Pain

Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies — NEJM – Nora D. Volkow, M.D. [Director of the National Institute on Drug Abuse (NIDA)], and A. Thomas McLellan, Ph.D. – Mar 2016 – free full-text article

I’m reposting this classic paper, which ironically came out the same month as the CDC Guidelines. Those guidelines showed zero understanding of the latest research and facts about opioid abuse and chronic pain that our own government is aware of.

Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage.

The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction   Continue reading

Inflammation → Hyperalgesia → Chronic Pain

C-reactive protein and cold-pressor tolerance in the general population: PAIN – July 2017

I’m reposting this study because it explains that hyperalgesia, which is blamed on opioids, arises from chronic inflammation and the numerous chemical changes this causes in the body over time.

Pain and inflammation are related:

systemic inflammation may lead to a variety of pain states, and, in turn, persistent pain causes an upward adjustment of proinflammatory mediators that sometimes elicit a prolonged low-grade immune response, leading to long-lasting, subclinical inflammation.
Continue reading

Measurement of Chronic Pain and Opioid Use Evaluation

Measurement of Chronic Pain and Opioid Use Evaluation in Community-Based Persons with Serious Illnesses | Journal of Palliative Medicine – by Kathleen Puntillo, and Ramana K. Naidu – Mar 2018

I had high hopes for this paper after reading the abstract and finding this conclusion, which feels so spot-on:

Conclusions:

Accountability for high quality care for community-dwelling patients requires selection of metrics that will capture the

  • burden of chronic pain and
  • beneficial use or misuse of opioids.

Continue reading

Opioid analgesic tolerance without hyperalgesia

Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release m… – PubMed – NCBI – Aug 2012

Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief.

How can a doctor determine whether a patient’s increasing pain is attributable to “advancing underlying disease” or tolerance to opioids?

It’s impossible for anyone except the patient to determine this. Even for myself, it’s difficult to distinguish between increasing pain versus increasing tolerance to the medication.   Continue reading

Latest review of Opioid-Induced Hyperalgesia

Latest review of Opioid-Induced Hyperalgesia in the Nonsurgical Setting: A Systematic Review. – PubMed – NCBI – Am J Ther. – Jan 2018

BACKGROUND:

Opioid-induced hyperalgesia (OIH) is a phenomenon that causes an increased pain sensitization and perception of pain to noxious stimuli secondary to opioid exposure.

While this clinical effect has been described in the surgical setting, it is unclear if OIH occurs in the nonsurgical setting.

Yet, some doctors are quick to blame any pain patient’s increased pain on this mythical phenomenon. Instead of prescribing more opioids, they use your additional pain as an excuse to cry “OIH!” and taper you down.   Continue reading

Hyperalgesia in Buprenorphine Maintenance Treatment

Pain Tolerance in Buprenorphine Maintenance Treatment – by Brandon May – April 13, 2018

Here’s an article showing the potential danger of this treatment, which results from buprenorphine binding more tightly to opioid receptors. Therefore it blocks more effective opioids while not relieving pain as well itself.

The actual study detailed in this article has a more bluntly honest title: Buprenorphine maintenance subjects are hyperalgesic and have no antinociceptive [pain relief] response to a very high morphine dose .

And from Wikipedia: “People on high-dose buprenorphine therapy may be unaffected by even large doses of opioids for episodes of acute pain. It is also difficult to achieve acute opioid analgesia in persons using buprenorphine for opioid replacement therapy.”    Continue reading

Hyperalgesia in With Hypermobility and EDS

Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers‐Danlos Syndrome Hypermobility Type: A Discriminative Analysis – Scheper – 2017 – Arthritis Care & Research – Wiley Online Library – Pediatric Rheumatology – Free Access – August 2016

The phenotypes of hypermobility syndrome (HMS) and Ehlers‐Danlos syndrome hypermobility type (EDS‐HT) are characterized by generalized connective tissue laxity and connective tissue fragility.

Due to the compromised structural integrity of connective tissue, individuals with HMS/EDS‐HT are assumed to be more prone to injury and consequent disability.

Yes, the above sums up the situation with EDS perfectly.   Continue reading

JAMA Opioid Study Proves Rx Opioids Safe

What the JAMA Opioid Study Didn’t Find — Pain News Network – March 10, 2018 – By Roger Chriss, Columnist

A recent opioid study published in the Journal Of the American Medical Association (JAMA)  evaluated pain management in patients with hip and knee osteoarthritis and low back pain

The study by VA researcher Erin Krebs, MD, and colleagues found that “treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.”  

Pain patients know this is simply untrue – at least for those of us who suffer from serious, daily, intractable pain.  Continue reading

High Quality Study Shows NO Hyperalgesia

Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine. – PubMed – NCBI – Pain. 2012 Aug

This is the highest quality of research design: double-blinded, randomized, and placebo-controlled – you can ask for nothing more – and it showed NO hyperalgesia.

Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief.  

How would a doctor or even a patient be able to tell the difference between increasing tolerance and “advancing underlying disease”?  Continue reading

Review of opioid-induced hyperalgesia

A comprehensive review of opioid-induced hyperalgesia. – PubMed – NCBI – Pain Physician. 2011 Mar-Apr – Free full text

Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids.

The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.

When a patient has this (which has never been proven in humans), giving more opioids leads to more pain, instead of less. Continue reading