Pain Worsening From Opioids Rare

Pain Hyperalgesia is a condition where “allegedly” you become more sensitive to pain once on opioids. This is used by opioid-haters that tell of doom to those on opioids. A Stanford associated study couldn’t find any and another failed to ascertain it as well.

IASP Poster PH 390, Montreal 2010
TOLERANCE AND OPIOID-INDUCED HYPERALGESIA IN PATIENTS WITH CHRONIC NONRADICULAR LOW-BACK PAIN AFTER ONE MONTH CHRONIC MORPHINE THERAPY
L. F. Chu, A. K. Zamora, C. A. Young, D. J. Clark, Anesthesia, Stanford Univ., Stanford, CA, USA

  • Randomized Prospective Double Blind Trial – can’t get much better than that
  • 139 chronic low-back pain patients
  • Half worked up to about 78 mg Morphne and has some decrease of their pain level and decrease of their disability
  • Every month, remifentanil infusions were give in conjuction with a cold pressor test and a heat test. Initially, the remifentanil helped thier pain tolerance, but by second month was not present as opioid tolerance kicked in
  • In no case was their pain sensitivity increased – so much for opioid induced hyperalgesia
  • “the morphine patients experienced a 1.9-fold greater reduction in VAS pain levels (44% vs. 23%) and a 5.1-fold greater improvement (31% vs. 6%) in Roland-Morris Disability Index. The differences in VAS pain levels (p=0.003) and self-reported disability (p=0.03) between both treatment groups were statistically significant.”

Also at the Conference:

IASP Poster PW 063, Montreal 2010
HYPERALGESIA IN CHRONIC PAIN PATIENTS AT RISK FOR OPIOID MISUSE
R. Edwards

  • 208 chronic pain patients – 60% on opioids – analysed for high or low risk opioid abuse potential

high-risk group

  • “reported higher levels of clinical pain,
  • had lower pressure and heat pain thresholds at multiple body sites
  •  had lower heat pain tolerance
  •  rated repetitive mechanical stimuli as more painful relative to the low-risk group (p<.01)
  • Measures of affective distress explained some, but not all, of this group difference in pain responses”

None of Thresholds varied from opioid to non-opioid group

Conclusion – “we did not observe opioid-induced hyperalgesia” – just more sensitivity in high risk opioid group.

 

Comment – This opioid hyperalgesia question has been used to mark all pain doctors as “bad” and making the patient worse. I can only think of a couple cases I thought about it and one was a high risk subject. Dr. Merskey when asked, stated he has never seen any. It seems to be alot of hooey rubish…

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