Opioid Hyperalgesia

[DUTCH45]

Have anyone heard of this before. My pain doc mentioned this to me last August and said "you are going to think I am crazy, but there are studies that indicate opioids can contribute to the level perceived by an individual". In other words the opioid is not working anymore. Here is a study that was presented at the 24th annual conference of the American Academy of Medicine. Long story short have been on oxycontin, methadone, morphine sulfate, and other meds over the last 8 years and I tapered off and stopped all opioids and now manage my pain with Tramadol only. I hope you are able to copy this url into your computer and read the article.


http://www.medscape.com/viewarticle/572104

[Boxerlover]

This topic can be a very sensitive subject for pain patients. I can't speak for anyone but myself, but from reading many of people's posts and stories, they are very similiar to mine. Many of us suffered for years without either any pain control or inadequate pain control. Then when we finally were able to get on a pain management program, the titration was a slow process. So now hearing about "hyperalgesia" especially in todays climate concerns me that this could now be used as the excuse to either lower dosages and or take patients off of narcotics for doctors fearing the DEA or no longer wanting to deal with pain patients.

Near the end of the arcticle they listed some things to be observant about that could suggest "hyperalgesia", or just escalation and progression of disease or tolerance. As long as those are considered and it is not taken lightly or done quickly it may be a legitimate reaction. But unless I read it wrong, they only used 6 subjects and in my opinion much more research would be needed before this becomes either accepted or common is pain management. I also found it interesting that they said they really didn't find any in cancer patients. Today, cancer patients aren't too different from chronic pain patients as more people survive cancer. I'd like to see less distinction between the two as it suggests that cancer patients suffer either more or differently than chronic pain patients. Now if you are talking about a terminally ill cancer patient that is a whole other issue.

Just my opinion.
Melissa

[Mark N]

I couldn't get to the link but I agree with Melissa on this. I know I am thankful that I haven't had to increase my dosage in several years. Articles like you pointed out is one of the big reasons I am so glad about not needing more medications.

[Lil E]

It does happen but not often. How many more reasons are they going "discover" to take the med option away? After 12 years its the only thing left for me.

[hoops2u]

I will attempt to access that article. I just want to say that I have been able to titrate down my own morphine based medication. I have been taking this med for more years than I can remember, perhaps 8. I had several increases through time to get to a good working dose.

Since I have been having increased pain of late, and feelings of great fatigue, I just wondered if my pain would increase with lower doses of the morphine based med. My pain did NOT increase with the reduction of my Morphine Med. There was no change whatsoever. I surmised from that, the increse I had last obtained, truly did not mask any pain symptoms.

Although I haven't found anything that does help either. I have tried many different BT meds. I am kinda sick of meds. Think I will try YOGA. Who knows? And if I am lucky, it will become habit forming.....

Blessings
hoops

[Lil E]

Morphine wasn't very good for me, not strong enough. I have been using dilaudid and use less than I did morphine as dilaudid is stronger and a much cleaner med.

[DUTCH45]

I don't think the purpose of the article in regards to opioid hyperalgesia is to take needed pain meds from us that need pain meds, but this is something that may help some chronic pain sufferers and also give our bodies a break from any damage that is occuring to our livers, stomachs and whatever else.

All I know is it worked for me. I thought I would pass the article along just for FYI. If you or your doctor aren't interested in this medical concept, that is between you and your doctor. Like most of you, I am willing to try almost anything to stop or lower my pain and at this time I am at my lowest pain level in over 8 years!

[Stella Marie]

I was forced to change pain specialists and the one totally disagreed with the used of Fentora (oral fentanyl) I was using for BT pain. When I was forced to d/c the Fentora and reduce my Duragestic patch strength - I thought this was going to be the end of my pain relief. I was shocked, after about 6 weeks I had a dramatic decrease in what I would describe and nonspecific pain. I still use the Duragesic patch and Dilaudid, but the lower doses did a better job for my pain control.

It thought this whole thing was just some theoretical nonsense when my dr discussed it - maybe for someone else - but not my pain. The new PM specialist did me a favor.

[Kandra]

I agree with Melissa....you can't base any change of someone's med regimen based on a six patient study. I think the only reason it was published was because of the issue of opioids...IOW, if a six patient study was done on an antibiotic it would most likely not be published without further empirical data.

I'm happy that Tramadol is currently working for your pain. I wish I could take a Tylenol and my pain would become a non-issue. Stella, do you think if you'd continue to lower the Fentanyl patch and decrease the Dilaudid your pain levels would come down even more? If so, definitely go for it!! I'll be cheering :) :)

Unfortunately for me, and others, decreasing our meds at least at this time doesn't seem to be an option :(

[DUTCH45]

I guess no one googled hyperalgesia. As an update to me personally, after 8 years of opioid and lastly ultram meds, I am off all pain meds! Here is a little info from wikepedia:
Opioid-induced hyperalgesia
From Wikipedia, the free encyclopedia
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Opioid-induced hyperalgesia[1] or opioid-induced abnormal pain sensitivity[2] is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.[3]

Although tolerance and opioid-induced hyperalgesia both result in a similar need for dose escalation, they are nevertheless caused by two distinct mechanisms.[4] The similar net effect makes the two phenomena difficult to distinguish in a clinical setting. Under chronic opioid treatment, a particular individual's requirement for dose escalation may be due to tolerance (desensitization of antinociceptive mechanisms), opioid-induced hyperalgesia (sensitization of pronociceptive mechanisms), or a combination of both. Identifying the development of hyperalgesia is of great clinical importance since patients receiving opioids to relieve pain may paradoxically experience more pain as a result of treatment. Whereas increasing the dose of opioid can be an effective way to overcome tolerance, doing so to compensate for opioid-induced hyperalgesia may worsen the patient's condition by increasing sensitivity to pain while escalating physical dependence.

If an individual is taking opioids for a chronic non-cancer pain condition, and cannot achieve effective pain relief despite increases in dose, they may be experiencing opioid-induced hyperalgesia. In this case, they may benefit from complete withdrawal from opioid therapy. Many individuals report reduced pain levels when opioids are withdrawn.[5]

The precise mechanisms underlying opioid-induced hyperalgesia are poorly understood. The sensitization of pronociceptive pathways in response to opioid treatment appears to involve several pathways. Research thus far has primarily implicated the abnormal activation of NMDA receptors in the CNS. One possible strategy for treating hyperalgesia involves blocking activation of these receptors with NMDAR antagonists such as ketamine, dextromethorphan, or methadone (which has NMDAR antagonist properties in addition to being an opioid analgesic). Human studies examining the benefit of combining opioid treatment with NMDAR antagonism have yielded mixed results, and few conclusions can be drawn until larger studies are conducted. Targeting the NMDA receptors in areas of potential pathology (such as the dorsal horn of the spinal cord) is a challenge considering their widespread presence throughout the spinal cord and brain, and the profound psychotomimetic side effects associated with known NMDAR antagonists may limit their clinical potential as adjuvants to the treatment of pain.





[edit] References
^ Angst, MS & Clark, DJ: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology 2006; 104:570–87
^ Mao J: Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain 2002; 100:213–7
^ Celerier E, Laulin J-P, Corcuff J-B, Le Moal M, Simonnet G: Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process. J Neurosci 2001; 21:4074–80
^ Chu LF, Angst MS, Clark D. Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain. 2008 Jul-Aug;24(6):479-96. PMID 18574358
^ Wuitchik, M. & Feehan, GG: Opioid withdrawal versus opioid maintenance for persons with chronic non-cancer pain: The experience of the Canmore Pain Clinic. Rehab Review 2006; 2:19-21
Retrieved from "http://en.wikipedia.org/wiki/Opioid-induced_hyperalgesia"

I only included the references since some were put off my a study with ONLY 6 persons.