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

Opioid based painkillers are extremely powerful and dangerous substances. While many patients see the drug as a potential option to treat long-term pain, they can worsen pain and lead to addiction. While at low doses, opioids can make a patient feel sleepy, higher doses of the substance can slow your heart rate, breathing, and even lead to a potential fatality.

While the typical use of painkillers is to treat pain and relieve hurting; opioids can also be known to make pain worse. There are two types of pain: acute and chronic. Chronic pain is typically defined as a pain lasting more than twelve weeks; whereas acute pain generally lasts for a short period of time. For those experiencing acute pain it can be caused by injury, surgery, trauma, or medical procedure. Contrary to chronic pain, however, acute pain can usually diminish when the cause has been treated or healed.

Prescription opioids like hydrocodone or oxycodone are one of the many options for treating acute pain. However, studies have shown that, after being on opioids such as acetaminophen-oxycodone for more than four weeks, an individual can become more sensitive to the pain itself. As a result, when a person experiences a minor injury, such as a stubbed toe, for instance, being on opioids can make their pain much worse.


UNDERSTANDING ACCELERATED OPIOID DETOX


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 decrease the ability of the body to create endorphins. As a result, a person loses the ability to decrease and treat pain naturally.


Signs You Are At Risk for Opioid-Induced Hyperalgesia

As opioids continue to be prescribed in order to treat pain, Opioid-Induced Hyperalgesia (OIH) becomes more of a significant issue. In order to understand if you are at risk for experiencing OIH, there are a few common evidential factors to consider.

Risk Factors of Opioid-Induced Hyperalgesia:

  • Methadone use
  • Opioid use
  • Tissue damage
  • Fibromyalgia patients
  • Shingles patients
  • History of substance abuse
  • Patients with co-occurring disorders (COD)

If you believe that you may be at risk for Opioid-Induced Hyperalgesia, there are certain warning signs that can trigger the need to consult a physician. For those experiencing hyperalgesia they tend to feel extreme pain even though their injury or condition may not be worse. If you are experiencing pain that feels as though it is getting worse over time and extending to other areas of your body, you may be experiencing OIH.

For many patients symptoms of Opioid-Induced Hyperalgesia include:

  • Decentralized pain
  • Pain that is difficult to define
  • Long-lasting pain

It is important to recognize that if you are feeling any of the symptoms above, treatment is available. While recovery from Opioid-Induced Hyperalgesia will take time, the majority of patients recover from this condition.


Treating Opioid-Induced Hyperalgesia at Coleman

For many patients that have increased their dose of opioids some unintended consequences can occur. Once you have prolonged opioid exposure many can experience a paradoxical effect called Opioid-Induced Hyperalgesia (OIH).

This condition is mostly defined as a paradoxical reaction where an individual receiving opioids for the treatment of pain can actually become more sensitive to certain painful activity. In addition, individuals have exemplified their personal symptoms of OIH as a "growing sensitivity to pain" while taking opioids.

What individuals taking the substance do not realize, is that opioids are not actually helping ease their pain. This dangerous drug is in fact making their pain worse. Individuals with OIH also may feel a lot of pain even if their health problem or injury may not be getting worse.

The upside to those experiencing Opioid-Induced Hyperalgesia, is that there are treatment options available. Many treatments use receptor antagonists that can block pain receptors and suppress your overall pain response. One of these antagonists is Naltrexone.

At The Coleman Institute, our Accelerated Detox plan specifically involves reducing and stopping opioid consumption. We use Naltrexone therapy to help patients focus on their psychological healing without the temptations to use again. This method has a 98% completion rate and can be diminished in as little as 3 days. It has also aided in reducing cravings for opioids, preventing relapse, and offering a more comfortable means to recovery.

We understand for many of our patients doing so can be difficult and frightening. Are you suffering from opioid-induced hyperalgesia? The Coleman Institute for Addiction Medicine has years of experience helping patients in this situation.

If you want to learn more, please call us at 804-294-2212.


Lauren Debski, FNP
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