Pain is the most common reason that people seek medical attention. Pain affects tens of millions of Americans and costs the United States billions annually in medical care and indirect costs from missed workdays and loss of productivity.

ID-100202691As I mentioned in an earlier blog, “Concerns about the Growing Misuse of Opioids,” a common treatment for severe chronic pain is strong medication such as opioids. However, some patients who receive opioids (for example: morphine or oxycodone) frequently need more and more of the drug to get the same pain relief. This is called tolerance.

Some patients continue to have pain despite their taking increasing doses of opioids, and may actually experience an increase in pain as a result of their increased medication. Additional medication in such patients will lead to ever increasing pain. This phenomenon is called Opioid Induced Hyperalgesia (OIH). OIH is diagnosed when there is no added relief with higher doses of your pain medication and you observe:

  • Your pain becomes different than the pain you originally had.  It may become widespread, extending to new areas.
  • The quality of the pain may change.  For example, you may experience allodynia, a condition in which normal sensation, such as light touch or a simple movement becomes painful.

Although the mechanism by which this occurs isn’t fully understood yet, cells not previously thought to cause pain, such as microglia, appear to be involved. At the Norman Marcus Pain Institute, I use very small doses (referred to as ultra low-dose) Naltrexone, which can block the effects of the microglia. This can not only decrease opioid side effects but in some patients reduce or eliminate the drug completely. It is clear that long-term use of opioids can do more harm than good for some patients.  Therefore, it may be wise to periodically attempt to decrease the amount of opioids to see if this either results in no increase or an actual decrease in pain.


Filed under: pain management

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