Do Prescription Opiates Make Chronic Pain Worse: The Risk of Hyperalgesia

By Anne Watkins

Chronic pain -- the medical term for pain that lasts at least three months -- is a potentially debilitating condition that affects millions of Americans.

The causes of the condition vary. For some people, it might be associated with conditions such as diabetes, arthritis or fibromyalgia. For others, it may result from an old injury or surgery that never fully heals.

When not adequately treated, chronic pain can seriously hinder one's ability to function, and it can even lead to depression, anxiety, chronic fatigue and other life problems.

Treatment of Chronic Pain

Treatment of chronic pain is usually targeted to the specific source of the pain, but there are a few common strategies. For pain that lasts a few months, doctors recommend getting plenty of sleep and exercise, eating well, and engaging in activities such as yoga and massage. Ideally, these tactics will ease the symptoms, if not make them go away entirely.

However, for serious cases of chronic pain that last six months or more, doctors and patients generally have to go to much greater lengths to tackle the condition. Things like acupuncture, nerve stimulation, numbing shots and surgeries are common practices. Sufferers may also need counseling to help deal with the mental effects of being in chronic pain.

In rarer cases, doctors may even prescribe long-term drug prescriptions for chronic pain. There are some antidepressants known to fight long-term pain, and there also various corticosteroids and anticonvulsants that may help. But for serious, long-term pain, there's a good chance that the patient will be prescribed an opioid analgesic -- a group of drugs that includes OxyContin, Morphine, Vicodin and other brand-name opiate medications.

However, in recent years, a new problem has come to light: While opiate medications can provide short-term relief to chronic pain symptoms, they can actually do damage in the long run. In addition to the negative effects of opiate addiction, there is also a condition called opioid-induced hyperalgesia, which is essentially a hyper-sensitivity to pain and other stimuli.

How Does Opioid-Induced Hyperalgesia Happen?

Hyperalgesia is closely related to tolerance, but it's important to distinguish between the two phenomena. Many patients who take opiate medications find that their tolerance to the drugs increases very rapidly, so that after as little as a week of regular use, they already need much more of the drug to achieve the same painkilling effect.

In serious cases, this can lead to a cycle of tolerance and upped dosage that causes the patient to sink ever deeper into physical and psychological dependence on the drug.

Without getting too technical about how hyperalgesia works, it essentially goes like this: In some people, regular stimulation of the opioid receptors in the brain causes the body to overcompensate in ways that increase sensitivity in the neural pathways that register pain. While the sufferer may not experience any ill effects when she has recently taken the drug, any time she goes more than the regular amount of time between, the hyperalgesia becomes acute.

How the condition feels is difficult to describe, but it's essentially a sensory hypersensitivity that is manifested as pain. For example, the sufferer may feel pain from the sound of someone stirring a spoon in a coffee cup, or she may find that things like bright lights or cold beverages cause feelings that are indistinguishable from real, physical pain.

Under these circumstances, it's essential to differentiate between hyperalgesia and tolerance. For hyperalgesia sufferers, the higher the dosage, the more their pain sensitivity will increase. Fortunately, word about this condition is beginning to spread through the medical community, and doctors are being more careful about upping the dosage on opiate medications.

Results of Hyperalgesia

Hyperalgesia results in nerve damage, which means that the condition doesn't just go away when the patient stops taking the opiate medication. The pain sensitivity stays and may continue to worsen until the patient gets medical attention. In severe cases, the resulting pain may even be worse than the initial pain that the opiate medications were meant to treat.

Treatment for opiate-induced hyperalgesia can be quite difficult, as different patients tend to respond to treatments in vastly different ways. However, many of the other standard treatments for chronic pain tend to help with hyperalgesia. In fact, hyperalgesia can be thought of as a form of chronic pain very similar to fibromyalgia, a condition characterized by chronic pain and discomfort throughout the body.

Alternatives to Opiate Medication for Chronic Pain

Not everyone who takes opiate medications for chronic pain gets hyperalgesia. Doctors haven't fully gotten to the bottom of why it happens, but it's clear that it only afflicts people who are predisposed to it, for whatever reason.

However, even if you're not sure whether you're predisposed to hyperalgesia, it's a good idea to look into alternatives to opiate medication. Long-term use of opiate medication can lead to addiction, and opiate dependence is one of the hardest addictions to beat, so it may be best to go with a different type of treatment from the start.

Alternative treatment methods include taking over-the-counter pain medications such as acetaminophen. These are not as powerful as opiates, but when used in combination with other treatments, they can be just as useful.

Some doctors recommend things like massage, yoga and physical therapy designed to relieve pain while improving your functioning. There are also a few different types of electrical therapies, and a list of truly "alternative" therapies, including acupuncture, aromatherapy, hydrotherapy, homeopathy, hypnosis, magnet therapy and meditation. You'll find few doctors who actually promote these methods, but they have been known to work for some people.

Meanwhile, if you're currently on opiate medications for long-term pain and you're worried that you may have a developing case of hyperalgesia, it's a good idea to change your treatment as soon as possible. If you're worried about detox and opiate withdrawal, talk to your doctor about opiate replacement treatment with Suboxone or methadone.

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Do Prescription Opiates Make Chronic Pain Worse: The Risk of Hyperalgesia