A patient shared this story and this question with me a few weeks ago:

“For the past two years, I have been working with a pain management doctor to find a remedy for my back pain. I tried every treatment in the book from physical therapy, to ibuprofen, to cortisone injections. After months of consulting with my doctor, we arrived at the perfect regimen: one tablet of acetaminophen-oxycodone, a potent opioid, in the morning and one tablet of acetaminophen-oxycodone at night.

This medication can be taken every four hours as needed for breakthrough pain. This pill brought my pain from a 10 to a 2. I started this regimen in 2017 and have continued this regimen until today.

Recently, I was running after my grandson around the basement, where I proceeded to stub my toe. (A stubbed toe refers to an injury, where a person suddenly hits or jams their toe.) I felt an excruciating, intense pain in my toe. My usual pain level went from a 2 to 11, off the charts. The pain was simply unbearable for several hours. Why was my pain so unbearable? I thought I was on the perfect regimen taking acetaminophen-oxycodone twice daily!”

Why Pain Can Be Worse With Opioid Painkillers

Pain is a common symptom that we all experience. Unfortunately, it is also quite unpleasant. There are two types of pain: acute and chronic. Chronic pain is defined as pain lasting more than twelve weeks.

Studies have shown that, after being on opioids such as acetaminophen-oxycodone for more than four weeks, a person may become more sensitive to pain. As a result, when a person experiences a minor injury, such as a stubbed toe, being on opioids can make their pain much worse.


An opioid’s primary mechanism in the body is to block pain. So how do opioids block pain? Pain is transmitted through the body by the brain and spinal cord. Pain signals travel through the brain and spinal cord by receptors on nerve cells. Opioids block these receptors on nerve cells, thus blocking pain signals and messages.

It is interesting to note that after opioids wear off, the body reacts by producing more receptors on nerve cells to allow the pain signal to travel throughout the body.

Opioid-Induced Hyperalgesia

Increased production of nerve receptors can be associated with increased pain. Over time, chronic use of opioids causes opioids to become less and less effective and leads to the production of more and more nerve receptors. As a result, a person has a heightened response to pain, known as opioid-induced hyperalgesia.

Lastly, our body has natural substances, known as endorphins, which behave similarly to opioids. Endorphins block pain responses. Studies have shown that long-term use of opioids decreases the ability of the body to create endorphins. As a result, a person loses the ability to decrease and treat pain naturally.

Treating Opioid-Induced Hyperalgesia at Coleman

Treatment for opioid-induced hyperalgesia involves reducing and stopping your opioid consumption. Doing so can be difficult and frightening. Are you suffering from opioid-induced hyperalgesia? The Coleman Institute for Addiction Medicine has many years of experience helping patients in this situation.

Our Accelerated Opioid Detox using the Coleman Method helps 98% of patients successfully complete the acute withdrawal process and begin naltrexone therapy, which reduces cravings for opioids and helps prevent relapse. If you want to learn more, please call us at 877-773-3869.

Lauren Debski, FNP