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…