ATTN Joe_Z: Opioids can actually increase pain
- From: "OldGoat" <oldgoatmail@xxxxxxxxxxxxxxxxxx>
- Date: Fri, 22 Aug 2008 01:04:44 -0400
Just a quick note. The link in this story is worth checking out. Good info
comparing tolerance, addiction, pseudoaddiction, and hyperalgesia or
increased sensitivity to pain. I know Joe had a concern on this, but
everybody can probably find something interesting. Again it's the link after
the 1st paragraph, not this article. It's a pdf. file.
Opioid Painkillers Sometimes Make Pain Worse, According to Evidence Review
As new evidence becomes available, healthcare providers are becoming
increasingly aware that ongoing opioid therapy for chronic pain might
actually worsen the pain in some patients - a condition called
Opioid-Induced Hyperalgesia or OIH.
Chicago, IL, August 20, 2008 --(PR.com)-- Opioid medications are essential
for helping to relieve all types of serious pain. However, relatively recent
evidence suggests that in some patients they can paradoxically worsen the
"Actually, this possible negative effect of opioids, such as morphine, to
cause increased sensitivity to pain was observed in the 19th Century," says
Peggy Compton, RN, PhD. "Today, we call this opioid-induced hyperalgesia, or
Compton is an Associate Professor of Nursing at the UCLA School of Nursing,
Los Angeles, and a well-known researcher and author in the pain management
field. Her extensive review of the clinical evidence on OIH, exclusively for
Pain Treatment Topics and published at the Pain-Topics.org website, is
titled "The OIH Paradox: Can Opioids Make Pain Worse?"
The full document can be accessed at:
Fortunately, it seems that OIH does not arise in the majority of patients
taking opioid analgesics, but when it does occur it can be difficult to
manage. In addition to OIH, pain increasing during opioid therapy can
indicate several other conditions that must be considered, including: 1)
worsening pain-causing disease, 2) tolerance to opioid effects, 3) opioid
withdrawal symptoms, or 4) pseudoaddiction (opioid-seeking due to unrelieved
pain). For these conditions, increasing the opioid dose usually helps
A patient who is addicted to opioids may complain of worsening pain but may
not be helped by increasing the opioid dose. In fact, signs of addiction may
emerge further, such as difficulty controlling opioid use, a preoccupation
with obtaining opioids, or other misbehavior.
In the case of OIH, increasing the opioid dose will actually make the pain
worse. Often, the pain is difficult for the patient to describe and can
spread beyond the original point of pain. According to Compton's review,
several strategies may help prevent OIH or to deal with OIH if it occurs:
The opioid dose should be kept as low as is clinically effective for
Additional medications can be used to help minimize the need for opioids,
such as COX-2 inhibitors, dextromethorphan, and others.
Long-acting opioids are preferred over shorter-acting formulations for
If a particular opioid becomes ineffective, it is often helpful to rotate
to a completely different opioid drug (methadone is especially useful for
New research suggests combining low-doses of opioid antagonists (eg,
naltrexone) with opioid therapy to counteract development of OIH.
Compton observes that there are still many unanswered questions about OIH,
and research investigations are ongoing. Meanwhile, it is essential for
healthcare providers to carefully monitor patients' responses to opioid
therapy and recognize that several opioid-related responses other than OIH
can lessen opioid-analgesic effectiveness. In some cases, higher dosing is
needed; however, if OIH occurs, other strategies should be employed to
provide patients the pain relief they need and deserve.
- Prev by Date: New treatment for Muscle related pain.
- Next by Date: Re: Killer methadone?
- Previous by thread: New treatment for Muscle related pain.
- Next by thread: Re: ATTN Joe_Z: Opioids can actually increase pain