Opioid Use and Hyperalgesia Explained: What It Is and How to Manage It
Opioids are commonly prescribed to manage chronic pain, offering significant relief. While many are aware of the risk of developing tolerance, dependence, and addiction with long-term opioid use, another unintended consequence of chronic opioid use is a condition known as opioid hyperalgesia.
This term refers to an increase in sensitivity to pain that paradoxically develops in individuals who have been using opioids for an extended period of time or at high doses. Individuals with this condition can actually have worsening and more widespread pain when using opioids.
This phenomenon can be distressing for those who rely on opioids for pain management and can be mistaken for opioid tolerance or withdrawal symptoms. Addressing this issue typically requires reducing or discontinuing opioid use, which can be particularly challenging for those with opioid use disorder (OUD).
Fortunately, there are various strategies available to manage and overcome this condition, including alternative pain relief methods. Understanding opioid hyperalgesia is crucial for effectively managing chronic pain and aiding recovery in individuals with Opioid Use Disorder (OUD), highlighting the significant impact that medical detox for opioid addiction and rehabilitation centers can have in both addiction and non-addiction cases.
What Is Opioid-Induced Hyperalgesia (OIH)?
Opioid-Induced Hyperalgesia (OIH) is a perplexing condition where prolonged use of opioid medications unexpectedly heightens a person’s sensitivity to pain. Rather than alleviating discomfort, these opioids can actually amplify the sensation of pain. An article in Pain Physician notes that the pain associated with OIH can either mirror the original pain or manifest differently, such as an increased sensitivity to heat.
Opioids act on the central nervous system to decrease the perception of pain. Still, in the case of OIH, opioids may have the opposite effect, increasing the nervous system’s perception of pain.
OIH is most likely to happen with long-term or high-dose opioid use. Those suffering from OIH often find that everyday sensations, which would typically be tolerable, become intensely painful, like the irritation of rough fabric against their skin.
The precise reasons behind this phenomenon remain unclear, but it is thought that chronic opioid use leads to alterations in the nervous system. Over time, the brain and spinal cord adjust to the presence of opioids, resulting in an increase in excitatory neurotransmitters such as glutamate and a decrease in inhibitory ones like GABA, which typically help to mitigate pain signals. Consequently, the nervous system becomes more reactive to stimuli, leading to an exaggerated pain response.
It can be challenging to distinguish OIH from other issues like tolerance or the worsening of the original pain condition. However, some common signs include:
- Increased pain despite higher doses of opioids, which can even make pain worse.
- Pain radiates to other body areas beyond the original site of pain.
- Experiencing pain from things that shouldn’t hurt, like a light touch or clothing.
How Is Hyperalgesia Different from Tolerance or Withdrawal?
Patients experiencing Opioid Hyperalgesia often remain unaware of their condition, mistakenly believing that their pain medication is simply losing its effectiveness, as noted by VeryWellHealth. It’s well-established that prolonged use of opioids can lead to tolerance, necessitating higher doses or more frequent administration to achieve the same level of pain relief.
When tolerance develops, the brain and nervous system adjust to the ongoing presence of the opioid, diminishing its impact on pain receptors so that individuals may feel less pain at the exact dosage. However, in the case of tolerance, pain remains localized to the same area and doesn’t become widespread, as it can occur in OIH.
In addition to tolerance, a person can become dependent on opioids, meaning the body cannot function normally without them, which results in withdrawal symptoms when attempting to cut down use or cease the medication abruptly.
These withdrawal symptoms can manifest as a temporary spike in pain as the body works to recalibrate its pain signaling without opioids, alongside other symptoms such as anxiety, restlessness, sweating, muscle pain, abdominal cramps, diarrhea, nausea, and vomiting. However, pain should diminish over time as the body detoxes, and symptoms should begin to resolve within five to 10 days.
Distinguishing between tolerance and OIH can be challenging, but a clear indicator is whether increasing the dosage or switching to a different opioid alleviates pain. In cases of OIH, raising the dose may actually exacerbate the pain or spread it further, while additional symptoms and cravings for opioids typically accompany withdrawal.
Who Is at Risk for Developing OIH?
Anyone, including seniors abusing opioids in Florida, can potentially develop OIH. However, certain factors may increase the risk. Harvard Health Publishing reports that many factors affect how the brain interprets pain signals, and just as pain perception is individual, the level of hyperalgesia from OIH is not the same in all patients, as some may experience more pain based on their genetics and personal predisposition. Research on OIH is ongoing, but based on current knowledge, factors that increase the risk of developing OIH include:
- Chronic opioid use
- High-dose opioid therapy
- Pre-existing conditions such as fibromyalgia, neuropathy, or psychological conditions like anxiety or depression, which already make individuals more sensitive to pain
- Quickly increasing opioid doses.
- Specific types of opioids, particularly those with rapid onset and offset, like fentanyl
- History of opioid use disorder (OUD)
What Are the Options for Managing Reversing OIH?
The pain experienced from Opioid Hyperalgesia can be debilitating, and increasing opioid doses may exacerbate the situation. Managing and potentially reversing OIH requires a careful and often multidisciplinary approach. Effectively managing and potentially reversing OIH necessitates a thoughtful, often collaborative approach. This includes not only managing the opioid itself while considering possible withdrawal symptoms but also incorporating other therapies and medications for pain management.
Here’s an overview of the primary strategies for treating OIH:
- Opioid Tapering and Discontinuation – The initial step involves reducing or stopping opioid use, ideally following a tapering schedule to minimize withdrawal effects, all under a healthcare provider’s guidance. In some instances, rotating opioids or switching to a different one may alleviate OIH symptoms.
- Non-Opioid Analgesics – Medications like NSAIDs, acetaminophen, antidepressants, and anticonvulsants can offer relief for mild to moderate pain.
- Non-Pharmacological Therapies – Approaches at Florida drug rehabs with private rooms, such as physical therapy, exercise, psychological support, and integrative methods like massage and acupuncture can help relieve pain. In certain situations, nerve blocks or epidural injections might target specific pain areas.
- Opioid Recovery Programs – For those with a history of long-term opioid use, a comprehensive rehabilitation program can be beneficial in addressing opioid dependence and facilitating a safe detox process. These programs often include medication-assisted treatment (MAT) alongside psychological support and focus on the underlying causes of addiction for sustainable recovery.
Reach Out to WhiteSands Treatment for Recovery Options to Overcome Opioid Hyperalgesia
Opioid Hyperalgesia is a challenging and troubling condition that can affect anyone using opioids, but it often improves once opioid use is stopped. At WhiteSands Treatment, our experienced team of clinicians creates customized treatment plans to assist individuals in any circumstance, whether they are opioid-dependent or not, in safely discontinuing opioid use and exploring non-opioid alternatives for pain relief.
Our treatment programs start with medical detox, which offers 24/7 supervision and FDA-approved medications to alleviate opioid withdrawal symptoms and cravings. This is followed by comprehensive behavioral health programs that employ evidence-based therapies to tackle other issues related to OIH, such as finding alternative pain management strategies and addressing the root causes of addiction.
It is crucial to understand that while rehabilitation programs are often linked to substance abuse, they can also be adapted for those without addiction to help them safely stop using opioids and alleviate OIH symptoms.
If you’re interested in learning more about our opioid recovery programs, please call WhiteSands Alcohol and Drug Rehab in Florida at 877-855-3470. An admissions specialist can answer any questions you may have and assist you with the intake process.
External Sources
- Pain Physician – A comprehensive review of opioid-induced hyperalgesia
- VeryWellHealth – An Overview of Opioid-Induced Hyperalgesia and Allodynia
- Harvard Health Publishing – More opioids, more pain: Fueling the fire
If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.
About the Author
Jackie has been involved in the substance abuse and addiction treatment sector for over five years and this is something that she is truly eager about. She has a passion for writing and continuously works to create informative pieces that not only educate and inform the public about the disease of addiction but also provide solutions for those who struggle with drug and alcohol abuse.
