Can Increased Pain Be Seen With Using Opioids?
Usually when opioid medications are prescribed, the result is excellent pain relief. Side effects experienced may include sedation, constipation, depression, or tolerance. With fifteen percent of America experiencing chronic pain, it is no surprise arizona pain doctors are prescribing opiate medications with alarming frequency.
Is it possible for chronic opioid therapy to make patients worse? The answer is yes, and it is termed opioid-induced hyperalgesia (OIH). It is a paradoxical condition whereby patients become oversensitive to acute pain. There is a scarcity of literature on the subject of how often it occurs, what presents risk factors for its occurrence, and whether or not there is a dosing relationship for narcotics towards developing OIH.
Most importantly, no one accepted preventive strategies exist or exactly how it should be managed once OIH develops.
Opioid induced hyperalgesia is different than when a patient develops tolerance. With tolerance, the medication dose may just be increased for the desired effect. With OIH, this will not be the case since sensitization exists and increasing the medication dose would just make the pain worse.
An individual with OIH may become over sensitive to certain painful stimuli. The pain experienced may be the same or different than the original pain experienced.
It is unknown exactly why patients develop OIH. There is some research showing that genetics may be a predisposing factor, however, it has not been explored sufficiently. Other studies have shown an association between opioid metabolites and hyperalgesia (increased sensitivity to pain).
Numerous observations have shown most often the OIH occurs with chronic opioid exposure. The main thing it needs to be differentiated from is simple tolerance or clinical worsening of the patient's baseline pain with need for higher dosing.
Diffuse pain is typically produced with OIH, which quite often radiates to regions that were not painful before. OIH usually replicates opioid withdrawal with some of its symptoms along with increased pain. Along with that, if the person is dealing with tolerance, a higher dose would reduce the pain. This is not seen with OIH, in fact, the pain would probably get worse.
OIH treatment can be perplexing, stressful, and time consuming for both the patient and arizona pain doctors. Switching to a different class of opiates may help. Trying non-narcotic meds and decreasing opiate dosing may work, along with trying interventional pain treatments to decrease the need for meds or potentially eliminating them altogether.
If these approaches are not successful, here are some more things to attempt:
- Attempt combination therapy with Cox-2 NSAID medications
- Utilize a class of medications called NMDA receptor antagonists
- Increase the opioid dose to see if it works, and the patient is dealing with tolerance rather than OIH.
- Use opioids like methadone or buprenorphine which have properties with the potential to prevent or reduce OIH.
- Desensitization treatments with chiropractors phoenix.
Opioid induced hyperalgesia should be placed into the mix as a potential diagnosis if chronic opioid treatment is failing. It is becoming more prevelant as the sheer numbers of patients in the US receiving chronic pain medication has risen exponentially over the past decade.
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