Worsening Pain (Opioid-Induced Hyperalgesia)
It might seem to run against common sense but opioids, as medications prescribed to reduce pain, in some people, can causes the opposite effect, making pain worse instead of better. This paradoxical reaction to opioid medications is known as opioid-induced hyperalgesia (OIH). OIH can happen at any dose of pain medication but typically occurs at higher doses. It should be understood that OIH does not happen to everyone taking opioids, nor does this reaction begin immediately when a patient first starts taking opioids. Instead, OIH occurs gradually over time, as the opioids increasingly sensitize the body toward pain.
The typical response to patients’ reporting increasing pain is often to increase the dosage of pain medications. Initially, the higher dose seems at first to bring the pain down but within a short period of time, the pain starts getting worse again, usually in the absence of further injury or other reasons for the pain to increase. Interestingly, the patients suffering from OIH often respond to cutting the dosage of pain medications down. However, it is usually very difficult to convince the patient suffering from OIH to accept this plan of treatment because they are already in more pain than they feel they can handle – the idea of cutting their medication dose down is usually met with disbelief and panic, sometimes with anger. Making it even more difficult to accept is the fact that reducing the dosage might not result in the immediate reduction of pain.
Adding insult to injury, physicians do not always recognize OIH. They might get progressively more and more uncomfortable with prescribing increasing dosage of highly regulated medications, then jump to the conclusion that the patient is either a drug-seeking addict or someone trying to get pain pills to sell. These physicians have sometimes pushed the opioid dosages very high when they panic and suddenly refuse to prescribe any more pain medications. The unfortunate patient then finds it all but impossible to find another physician who is willing to help because the dosage is uncomfortably high for new physicians to accept, especially when the patient has just been discharged from his/her previous physician under questionable circumstances. This unfortunate patient ends up going into terrible opioid withdrawal, and might feel there is no alternative but to turn to friends or relatives with pain medications, starting down a slippery slope to drug abuse and addiction.
It might seem to run against common sense but opioids, as medications prescribed to reduce pain, in some people, can causes the opposite effect, making pain worse instead of better. This paradoxical reaction to opioid medications is known as opioid-induced hyperalgesia (OIH). OIH can happen at any dose of pain medication but typically occurs at higher doses. It should be understood that OIH does not happen to everyone taking opioids, nor does this reaction begin immediately when a patient first starts taking opioids. Instead, OIH occurs gradually over time, as the opioids increasingly sensitize the body toward pain.
The typical response to patients’ reporting increasing pain is often to increase the dosage of pain medications. Initially, the higher dose seems at first to bring the pain down but within a short period of time, the pain starts getting worse again, usually in the absence of further injury or other reasons for the pain to increase. Interestingly, the patients suffering from OIH often respond to cutting the dosage of pain medications down. However, it is usually very difficult to convince the patient suffering from OIH to accept this plan of treatment because they are already in more pain than they feel they can handle – the idea of cutting their medication dose down is usually met with disbelief and panic, sometimes with anger. Making it even more difficult to accept is the fact that reducing the dosage might not result in the immediate reduction of pain.
Adding insult to injury, physicians do not always recognize OIH. They might get progressively more and more uncomfortable with prescribing increasing dosage of highly regulated medications, then jump to the conclusion that the patient is either a drug-seeking addict or someone trying to get pain pills to sell. These physicians have sometimes pushed the opioid dosages very high when they panic and suddenly refuse to prescribe any more pain medications. The unfortunate patient then finds it all but impossible to find another physician who is willing to help because the dosage is uncomfortably high for new physicians to accept, especially when the patient has just been discharged from his/her previous physician under questionable circumstances. This unfortunate patient ends up going into terrible opioid withdrawal, and might feel there is no alternative but to turn to friends or relatives with pain medications, starting down a slippery slope to drug abuse and addiction.