Man having back pain after taking too many opioids

What is Opioid-Induced Hyperalgesia?

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Opioids, such as codeine, morphine, and oxycodone, are commonly prescribed to relieve pain. While these medications are effective for short-term pain management, long-term use can sometimes lead to a paradoxical condition called Opioid-Induced Hyperalgesia (OIH). In OIH, rather than alleviating pain, opioids increase sensitivity to pain, creating new challenges for patients and healthcare providers. Let’s explore what OIH is, why it happens, and how it can be managed.

What is Opioid-Induced Hyperalgesia? 

Opioid-Induced Hyperalgesia (OIH) is a condition where prolonged opioid use increases a person’s sensitivity to pain. Instead of reducing pain, the opioids cause the nervous system to become more reactive, resulting in heightened pain sensations from stimuli that would not be normally painful. This condition is understandably frustrating for individuals, as the very medication meant to relieve their pain becomes a source of worsening pain. 

How Does OIH Develop?

OIH occurs due to changes in the way the central nervous system processes pain signals in response to long-term opioid use. When you take opioids, they bind to opioid receptors in the brain, decreasing pain signals. However, prolonged exposure to these medications alters the brain’s pain-processing pathways, making them more sensitive to stimuli. This is one of the many reasons why opioids are only intended to treat pain for a short period of time. They are not the best option for long-term pain management

There are other factors that contribute to OIH as well. Opioids are thought to increase glutamate, an excitatory neurotransmitter, which amplifies pain signals instead of suppressing them. These medications can also trigger the release of inflammatory chemicals in the nervous system, which can also increase pain perception. Lastly, if opioids are used for an extended length of time, the nervous system adapts by increasing the number of pain receptors, also contributing to heightened pain perception. 

Symptoms of Opioid-Induced Hyperalgesia? 

Opioid-Induced Hyperalgesia is often confused with opioid tolerance, but they are two different things. Tolerance happens when the body becomes less responsive to opioids, requiring an individual to take higher or more frequent doses to achieve the same effects. OIH, on the other hand, amplifies pain sensitivity, meaning the medication causes the pain to worsen. The main symptoms associated with OIH are: 

  • Increased sensitivity to pain, even when there is no known trigger 
  • Pain that spreads to other areas of the body beyond the original injury or issue 
  • Pain that worsens despite increasing the dosage of medication 
  • New types of pain, such as burning or stabbing sensations 

How is OIH Managed? 

Managing OIH is challenging, especially if you are developing physical or psychological dependence. You could be struggling with heightened pain sensitivity, as well as intense urges to continue using the opioid medication. Fortunately, treatment is available for both OIH and opioid dependence. The strategies that are most effective include: 

  • Reducing or tapering opioids: This gradually allows the nervous system to recover and get used to functioning without opioids. Pain sensitivity will not be as intense either. Your healthcare provider may also help you transition to a non-opioid pain relief option. 
  • Switching to a different opioid: If you are using the medication responsibly and are not at risk for dependence, your doctor may recommend switching to a different opioid. Different opioids interact with the nervous system in unique ways. 
  • Non-opioid medications: Pain can be managed without opioids, especially if it’s chronic. Some options include NSAIDs or acetaminophen, anticonvulsants, and antidepressants. 
  • Complementary therapies: Cognitive behavioral therapy (CBT) and mindfulness techniques can teach patients healthy coping strategies to manage chronic pain. Physical therapy, acupuncture, and others can also help reduce pain sensitivity.  

Preventing OIH When Taking Opioids 

Prevention is key to avoiding OIH, especially for individuals who need long-term pain management. If you must be on opioids to treat pain following an injury or procedure, it’s recommended to take the lowest dose possible for the shortest amount of time, incorporate non-opioid pain relief options from the beginning, and regularly meet with your healthcare providers to assess your pain levels and adjust your treatment plan. 

Treatment for Chronic Pain and Opioid Use Disorder

If you were prescribed opioids and are now suffering complications like OIH or dependence, it’s important to reach out for support. You can start with your doctor and then consider other treatment options, such as gradually tapering off the medication and pursuing rehabilitation. Awakenings Treatment Center is not just an ordinary recovery center—we also specialize in helping individuals cope with chronic pain without falling into the trap of addiction. Contact our admissions team to learn more about our outpatient services.