OPIATE INDUCED HYPERALGESIA

[opus88]

Has anyone else out there had this happen?
Where pain has actually increased when given opiates?
An increase in pain that is NOT due to tolerance...
An increase of pain that is even higher than before you began the opiates and perhaps the pain may even be(but not necessarily)  in an area of your body that the opiate wasn't prescribed to treat in the first place.
I'd like to hear from anyone who has had this happen

[Husky081280]

Hi, I've been taking OxyContin for three years and have found that I've had to increase the dose quite regularly to keep my pain levels manageable. Recently I have experienced excruciating pain all over my body including very bad aches in joints and muscles. I think it is down to the oxy. I stopped taking it but the withdrawal symptoms were unbearable. My doctors don't believe that the oxy could be making my pain worse and they just keep increasing it. I'm looking for alternatives and evidence that this could happen and it looks as though it does happen for a very small number of people using it for chronic pain management. Thanks to everyone who has had the courage to be honest here x

[kelly516]

I found this on Hyperalgesia..

http://www.prnewswire.com/news-releases/waismann-method-witnesses-increase-in-chronic-pain-cases-linked-to-opioid-induced-hyperalgesia-115333209.html

[opus88]

hi just found your reply....I thank you so much for your input.
Its all pretty much wht my doctor was trying to explain today...and pretty darn confusing to say the least...I appreciate having it all in print so I can read and re-read and do more research!
I was instructed in Sept to increase the gabapentin and also the oxycontin!
I took it upon myself to do just one med at a time how else would I know which was helping or not??
so now its been 6 weeks on the upped gabapentin with no relief.
Now I will began the upped oxycontin from bid to tid.....
and see what develops for me.
I first started oxycontin in March and by mid May my legs were excurciating pain(intermittant)...it took many months for my research to find this as a possibility.

I see from your earlier post that you also suffer from neuropathy, do you have your pain under control? and if so would you tell me what works for you.

again thx for the input

[opus88]

tuck and sandee
thx for the input!
I agree OIH is a relatively rare/controversial and complex phenomenon.
I hope my circumstances will in no way influence anyone from trying to obtain pain relief.
Everyone reacts differently to any medication and opiates are benificial to many CP ppl.

And yes you better believe I have researched this, for months I have read all I can find to search for answers because I couldn't understand what was happening to me and I NEED to understand.

Only after the research did I bring up the subject and symptoms to the 3 doctors involved in my care(a PMP, an Internist, and a pyschopharmacologist).
All 3 were in agreement that hyperalgesia/allodynia (notoriously resistant to opiate and NSAID analgesics especially in conditions involving peripheral neuropathy)...could well be a very real possibility for me.
The PMP said he was just abt to try to explain it to me himself, so he was glad I had done some research.

The increase in my neuropathic limb pain
-isn't due to a deterioration in my back
Nor due to a tolerance because oxycontin remains theraputic for this pain.
-also not due to long term use of opiates....I have taken for less than a year at the original dose.

My psychopharmacologist (just today)
wants me to continue with the recent increase of gabapentin 2700mg
with the addition of a high dose of folic acid along with the lamictal I am already taking he thinks this may act as a dual med. therapy(trial)
He also is encouraging me to ask my PMP(in Dec)...to consider switching the gabapentin to lyrica.

The PMP, did mention the possibility of switching oxycontin to methadone when I saw him in Sept. (I am hesitant) If needed I would prefer to try an opiate rotation strategy if he's in agreement.
First we are trying this higher dose of gabapentin and I will add another 10mg of oxycontin 3x per day...to see if this increases or decreases my neuropathic pain....

I am just hoping if there are others with same issues they will also post.....

again I hope this won't scare any chronic pain people out there. this is rare and only my own personal experience. everyone needs to be aware of but should never deter you from seeking pain management. Opiates may not be the right drug for me but it has given relief to many who would otherwise suffer needlessly.

thx for listening

[Uilleann]

Opioid Hyperalgesia (OIH) definitely exists. The definition of it is "the paradoxical development of increased sensitivity to pain as a direct result of opioid therapy through the upregulation of compensatory pronociceptive pathways." There is a molecule in the spinal cord called "dynorphin" that is increased and is  consistently observed following chronic opioid administration. Spinal dynorphin implicated in the development of enhanced nociceptive sensitivity  that exaggerates antinociceptive tolerance to opioids. Spinal administration of dynorphin antiserum blocks the expression of abnormal pain behavior and the development of antinociceptive tolerance in rodents dosed chronically with opioids.There are other chemicals implicated in the development of OIH such as nitric oxide and superoxide dismutase.  There is no practical treatment of this condition except to switch off mu-receptor based opiated such as the common ones: morphine, fentanyl, oxycodone, hydrocodone etc. But first, one needs to know if one has it. If you increase the dose and your pain increases, then this is a likely possibility. Alternatives to mu-receptor bonding opiates are those that work at the NMDA receptor such as methadone and there is another good NMDA receptor blocker called ketamine. They have been using this in Europe where they admit patients to an ICU and administer this over a few days (on a drip) for treatment of recalcitrant Complex Regional Pain Syndrome  with sympathetic features (also known as RSD). US insurance companies have not to date, to my knowledge, paid for this treatment, but it has been helpful for those with CRPS. You would have sympathetically maintained pain which are confirmed with lumbar sympathetic blocks for the lower extremity or stellate ganglion blocks for this type of pain in the upper extremity. Some interventional pain physicians also implant intrathecal pain pumps for patients who are on high doses of opiates but are developing side effects to these high doses. This would not be an option in opiate induced hyperalgesia. I hope that this response  has been of some help.

[Tuckamore]

Opus I am sorry that OIH is a possibility for you. I assume you have done a lot of research on the issue. It is controversial.

Recent evidence suggests that pain patients on chronic opioid therapy become more sensitive to pain (hyperalgesia) over time. Another clinical research has just been completed on this phenomenon which included only 160 patients in CA. The final results will be available at the end of this year. The belief is that in some ppl the pain signals being transmitted into the spinal cord become amplified with long term opiate use. Previously small studies have concluded that this can be true in some cases.

Methadone is different. It breaks down to methadone which is not a hyperalgesic substance. Some physicians view methadone as a good alternative to the hyperalgesics.  If OIH is suspected a physician will sometimes prescribe methadone or use it in rotation with hyperalgesics. How a PMP determines if a patients is experiencing OIH may vary form physician to physician.

It is important to know that this is a possibility and that it does not occur with everyone. As I have said numerous times on the PM Forum are systems are all different and we respond independently different to medications. OIH has been excluded in my case. But it was a concern I had. However I am still on the same opiate that I placed on approximately six years ago. I have had an increase but my condition has deteriorated. There are many factor to consider when your pain does not respond to an increase of medications or when you require more and more of an opiate to control your pain. It is not usually that you have OIH or that your tolerance has greatly increased.  

Sandee brings up a good point. I understand her statements. She is always concerned with our members. And yes there are so many fears that can deter ppl from seeking pain management, this is one of them. It's a sad fact that it does deter CP patients from taking opiates. It should also not deter a physician from prescribing opiates. A good PMP or pain managing PCP is aware of this phenomenon and will watch for the possible development of OIH. It should not scare a person with chronic pain into avoiding an opiate that can help return their functioning level and control their pain.

Opus I hope you and your physician will get to the bottom of your pain issues and obtain some releif. It sounds like you have a good PMP. We are here for you and as always wish you the very best.

Peace,
Tuck

[sandee1818]

Hi Opus,
I am really sorry your dealing with this and by no means what so ever did I want to minimize the pain your going through. I know it is difficult and I am very glad to hear you have a doctor that is willing to help you and I hope you do find the right regimen to help control your pain.
I am sorry the way my rant came off as if I had no concern for your problems with this.
I hope others will post that have this problem so maybe it will lead to some answers for you:)

[opus88]

yes Tray...I am most certainly dealing with it too. I see a PMP and he's almost certain this is my case...I am currently on a trial.
Tell me more abt your situation Tray.

Sandee, I hope it won't scare anyone from pain meds...its a matter of finding the right one to work for me, I will need to be on something long term however for some of us its going to be a puzzle to just find one.
I am currently on oxycontin it was prescribed for my back pain, I began this in March, it still has given me partial control in THAT AREA.
I am also dealing with chronic leg/thigh/hip pain this pain had been somewhat controlled with gabapentin.
Now since August my leg/thigh/hip pain has intensified 100%. my PMP increased the gabapentin to 2700mg...this increase has not worked.
now he wants me to increase the oxycontin to 'see what happens'...before he confirms the hypealgesia,
I have only done this the passed 2 out of 3 days(so far) I am really struggling with a decision right now.
The 2 days on the increase has helped.as the original dose in March did. I just struggle with for how long?
And IF it does make my leg pain worse It could/ will be almost unbearable before he finds a mix that will work on me.
So I would like to know what others have done when faced with this paradox.

[sandee1818]

I wanted to be a little clearer in my statement that this may "scare" someone in pain from trying opioids. I believe there is so much hype today in the media about these drugs being abused and causing terrible addictions and even death that it leaves some who desperately needing help scared to try them and they continue to live in pain. Living with pain is hard as we all know and it controls our lives at times. For those with no help as far as medication they have it even worse. To keep adding the reasons and fears of these kinds of medications that does help so many people live better and have a quality of life they would not normally have is not really helping anyone in my opinion.
I have heard of so very many people who live in so much pain and they will not even try these meds because they fear all the things listed that will cause them harm and it makes me so mad because this is the reason they were made to help people.
I hate to think of someone not trying the medications they need because they hear a bad story of someone who did have OIH or addictions or adverse reactions.
We never hear about the many, many people who have a much better life because of these medications.
While I know that these problems exist of addiction and diversion and OIH there also needs to be told the great success that these medications has had with so very many people.
Okay I had my rant, sorry:)

[TrayCee]

yes, it absolutely happens

[sandee1818]

I have not had this. I know it is a medical fact that this can happen but I also believe it may scare someone who is in alot of pain and needs help. I have not heard anyone have this happen to them here.
I would also like to hear if anyone has had this happen to them.