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Opioid-induced hyperalgesia reduces pain tolerance and heightens discomfort

May 03, 2012 - 24 comments
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prescription painkiller addict



Patients who are prescribed long-term prescription painkiller treatment programs should be cautious of opioid-induced hyperalgesia.  Opioid-induced hyperalgesia is a condition where the increased use of opiates, like Oxycontin and hydrocodone, heightens one's sensitivity to discomfort and reduces their tolerance for pain.  Essentially, people will increase the amount of painkillers they are taking as their discomfort continues to escalate, but the added medication can actually make their pain worse.  
Opioid-induced hyperalgesia is often times mistaken for a growing tolerance to pain medication, which is why dosages are increased. Unfortunately, increasing the dosage is not only ineffective, but can worsen the hyperalgesia and cause even more pain, creating a dangerous cycle.  The most effective and safest way to remedy the condition is to decrease the dose or detox and eliminate the pain medication altogether.  While it can be scary for a chronic pain patient to imagine no longer taking medication, we’ve actually seen patients suffering hyperalgesia realize they were pain-free once they relinquished their pills.  It’s very important that hyperalgesia be differentiated from chronic pain so doctors are able to properly treat the problem and lessen pain, without causing or escalating physical dependence.  Long-term opiate use can hinder or even stop the body's ability to produce natural endorphins, which is why many patients receive relief from pain once their bodies are able to recover this natural function.
If a patient is experiencing tolerance or opioid-induced hyperalgesia, the risk of dependency is very high.  Increasing dosage, which many patients do without consulting their physicians, can increase dependency risk and can even lead to overdose or death.  
At the Waismann Method Treatment center we take our patients to Domus Retreat after detoxifcation for a better evaluation on their pain level. We begin treatment with non narcotics and provide yoga, acupunture, massage and other forms on therapies that can help with prescription abstinance and pain control.

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by aheart, May 04, 2012
Thank you for this Clare, sorry not sure what to call an addition specialist but it was very informative and interesting.

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by CWKavinRAS, May 04, 2012
You are very welcome...

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by judith946, May 07, 2012
to clare: After an operation, I know I have nerve damage because the symptoms are exact. The Pain Clinic has shot my back 4 times and now I am in agony. I also had a minor motor seizure and had to have meds. $900 later, my co-pay in eight months, they did not look for the cause but only shot into two slightly bugling disks and some arthritis. The laws are now punishing patients that are in chronic pain. We are treated like criminals. I have been in pain since 2007 and the hydrocodone is not very effective. I finally was put on (3) 10 mg a day and told to try not to even take that.  At first, I was doing pretty good and did not know that they gave me energy but at least I had a life. Now, I am down most of the day. Talk about Medicare fraud, they make you come in every month to give you a refill and you do not even see the doctor. $30 from me and office visit billed to Medicare. I had close eye hallucinations from Tramodol and the doctor told me that was not so bad. The pharmacist could not believe it. So what if I have to live on drugs, it is at least living.


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by CWKavinRAS, May 07, 2012
Dear Judith946,

You should try to have the best quality of life you can without any judgment. The information above is for patients to be educated on the possibilities, but everyone is an individual with unique needs.
I have work with the Waismann Method for over a decade and our only goal is to give the patient a healthy and productive life. The manner that treatments are designed is by each patient’s specific needs.
I hear you loud and clear and sometimes is frustrating to say the least how the doctors can treat patients. Don’t take it personally; it is just the situation with prescription medications we have found ourselves in.
All the best.



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by judith946, May 08, 2012
Oh my gosh, I totally vented on you. Your kind and amazing response reassured me not to take it personally and that it is a struggle for everyone. I wish we could use our regular MD but Texas requires you go and pay every month for a refill and a drug test. Thank you for enduring my tantrum. That was one of the few times in my 5 years of pain that a professional has spoken words of compassion and respect to me. Also, just to let you know, your picture is so pretty.


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by CWKavinRAS, May 08, 2012
Thank you for your kind words and if I made you feel better than I did my job.
Wish you a healthy and happy life.

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by Carolina_D, May 15, 2012
I have been on VERY long term opioid 'therapy' and have worried about the exact thing you just talked about. I JUST got a dosage increase...slight, 20 more tabs of the same mg, after more than 3 years on the exact same dosage. It kept working for me for that long, but I began having severe breakthrough pain...I think that's what you call it, last month. I'm on 15 mg oxycodone (NOT oxyconton). The directions are 1-2 tabs every 4-6 hours as needed. Of course, I couldn't take the maximum dose (2 tabs every 4 hours) without running out of pills WAY too early. I have fibro, and am one of the lucky patients that opiates DO work for. I started off on hydrocodone in 1984, so I've been taking opiates that long. BUT, (maybe cos I'm 'flaring', the oxys don't seem to work well this month. I don't want to ask for a larger dosage, but was wondering if I switched back to hydrocodone if the change might work better, since they DO work a bit differently. I AM desperately afraid of withdrawals, and would love to get off of opiates totally, but my pain levels are honestly VERY high. Also, I would have to do it by myself, as my insurance would never pay for a program like yours and I am LOW income. I mean, VERY low income. Is this enough info for you to give me any advice at all? Thanks so much.

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by Carolina_D, May 15, 2012
I forgot to add that my pharmacy switched suppliers for the oxy this month. I'm wondering if the new pills just aren't as strong as the other ones, which was the brand I've been on for nearly 10 years now. In fact, my hydrocodone was that same brand too. Anyway, is this a possibility?

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by CWKavinRAS, May 15, 2012
The oxy pills do have a new formulation, we do receive a large number of call regarding that issue. Maybe that has been the issue with your breakthrough pain. You should discuss your concerns with your doctor before things progress. The issue with Hyperalgesia, is while you are taking opiates you cannot really evaluate your pain level.
I cannot tell you to take a drug or other, every patient is different and have unique needs, but as I mention before you should discuss your options with the doctor that is following you. Just your awareness to the issue is a  positive action to the solution.


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by Dee1956, May 16, 2012
Carolina_D  Hi I noticed that you said your pharmacy switched suppliers so your meds do not seem to be working
From what I have read generic drugs can (by lawy) be up to 25% stronger or weaker than the brand
This is true for all medications so some people have to ask for the brand name so that they know the dose will be consistent
Good luck.

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by nkkitsallgood928, May 18, 2012
hi  Clare, i found your post to b informative as well as challenging. I am a recovering addict 6 yrs now. i was rx klonopin in 1999 when my husband killed himself. and my life as a child was no peach iether. so i began therapy in 99. it was very helpful they diagnosed me as ptsd, gad, and most recently bi-polar. im also hypothyroid, post surgical menopause, after my histo is when they dx me bi-polar, i recntly had an epiphany n went in patient to get off klonopin its been 12yrs. they put valium taper in its place & i was down to 1 a day.( i never have  mesed around with rx)and i had a focal siezure and was smokin liks a chimney. boy i wanted a drink i saw a nuero doc. he explained the duration ive been on it is kinda kin to a diabetic & insulin. fast forward i just had another sx. and was in  great deal of pain almost 5 months b4 it & a good month after it , i was scared. i exptessed my feelings to anyone that would listen. i even said how the act of taking pills had an affect & told them during my liver tx. we used the fentanyl patch so i would not b taking pills & how well the tapering worked made me feel better, the docs insisted if im using them for pain then we should have no problems. well i was scared bcuz i am an addict & i know my mind is a liar, its been3wks since i took my last pill and im ok. whew. i should mention im allergic to & my psych meds interact with alot so it leaves me in a learch, on one hand docs dont wanna rx the meds i can take & we just moved so i have yet to have a relationship with my doc. all they see is fully sleeved tattoos( i do have all my teeth,lol) and former addict. my husband heard this same thing about opiates creating pain cycle,hes 19YRS clean n sober so its  touchy subject &he goes to all my app. except my shrink. its all good

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by Finallyachance, May 24, 2012
QUOTE  I hear you loud and clear and sometimes is frustrating to say the least how the doctors can treat patients. Don’t take it personally; it is just the situation with prescription medications we have found ourselves in.
All the best. QUOTE

I am not saying you are guilty of this as I have read all your post and have seen that you agree each patient is different therefore their specific needs vary and you treat them as such, but I find the above quote over-utilized by physicians when a patient to include myself needs pain medication or help with a pain crisis issue and....we have had to "deal with the pain" or "buy it off a friend or much worse stranger" because of the physicians refusal and/or hesitancy to prescribe much needed analgesics more so associated with the opioids.   I have found doctor's to use this instead of any apology or change in their manners as we are ushered out their door still in pain etc...what about the person's who have not used or abused the system why do we suffer this.  Sometimes such as I have chronic kidney and common bile stones where the pain is excruciating and if I could find a non opioid to relieve the pain great but to date I have not.  So....I become frightful/fearful when I get into an attack of either condition and I must visit an ER doctor or really any doctor and first go through the weeks of proving that the other meds are not helping etc....I think it is wrong for doctors to lean on this excuse and can be relative to an innocent person being sent to prison etc....

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by CWKavinRAS, May 24, 2012
There is absolutely no judgment from my part to any patient that takes opiates regardless of the reasons. I believe that we should be well informed about in whatever it is that we put in our bodies specially if it’s a drug. Once we understand the pros and cons we can make an educated decision of what will give us a better quality of life.



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by opus88, May 26, 2012
Dr Clare thank you so much for posting this very informative article,and making the public aware of this condition. its really not easy finding info on hyperalgesia. And many doctors tell you its all in your head.

What you describe is exactly what happened to me 3 years ago. I was prescribed oxycontin by a pain specialist for fibro and DDD, I was building up a tolerance quickly and the pain just kept getting worse and worse, strangely not in my lower back as it was prescribed for but in my legs....from hips to ankles just unbearable.

He kept telling me the increased pain was due to my condition worsening, but I was very skeptical...how could a condition  thats been more or less at the same level for a few years suddenly be deteriorating so rapidly? Finally after alot of research I questioned him about hyperalgesia, and he did agree with me that it was very possible thats what was happening. HOWEVER he wanted to try just ONE MORE increase to be sure, and if that proved true he would switch me to morphine........he was going to make me into an addict to treat pain that was at least something I could tolerate before the medication.
Scared the living beegeez outta me, I stopped seeing him and told myself somehow I was going to get off these pills and put up with a pain level that I could tolerate with minimum medication.
I stubbornly did it myself, took me a whole year to taper down gradually, and I knew I was doing the right thing b/c each decrease in the oxy also gave me a slight decrease in pain.

I've been totally off oxy for 2 years now, I still have a bad back and extremely painful legs but at a manageable level. I treat this with gabapentin,flexeril and tylenol also the occasional percocet 5/325 when I REALLY need a touch more relief.....I am soooo very glad not to be reliant on oxy anymore.
I do know it does work for some people out there that wouldn't be able to cope without it, but for some others like myself its a terrible medication.

thank you again

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by CWKavinRAS, May 26, 2012
Dear Opus88 you would be surprise to know the amount of patients we see that their doctors keep raising their medication due to Hyperalgesia symptoms. You can read more about it at our website opiates.com. We are trying to build a extended site for all information regarding opiates, opiate dependency , addiction, treatment , medications, conditions and etc…I believe the more educated patients are about their condition, the better choices they can make. By the way, I am not a doctor but a addiction specialist and I am glad to help.

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by opus88, May 28, 2012
I will check out that site, I too believe the patients need all the information possible on their conditions and treatment options..thank you again.

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by ccfadal, Jun 01, 2012
My 24 year old son died from a rare  heart virus in 2008.  He needed a transplant but the drs. listed him too late.  I have fought fibromylgia for years and I too  used the Lortab for pain relief.  However, after my son died I began taking them to cope for grief and the pain.  I was up to 20-30 hydros a day.  Finally, I went to treatment and stayed for 35 days.  I detoxed from Soma, Hydro, Tramadol, Benzos and Seroquel.  It took 21 days for me to begin to have natural pain reduction.  After treatment, I relapsed and was put on Suboxone.  I have been drug free for a very wonderful year now.  I realize most would say..."you are not drug free if you are on sub." I don't care what they say, this works for me.  Helps with my chronic pain and I feel better than I have in years. I care for my 86 yr old father and there is Fetynal and Lortabs in my home.  That would be like expecting an alcholic to work in a bar with easy access.  I plan on getting off the Sub when the time comes that my drugs of choice are not in my home.  It is so true tho what you say about the cycle of pain.  Very dangerous and that cycle is very hard to break.  Thanks for letting me vent.

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by CWKavinRAS, Jun 01, 2012
Dear ccfadal,

I am happy you have had a good year and you should be proud of yourself for having the strength and will power to still help others after all you have been through. There is no judgment from me , just my best thoughts and wishes are with you.

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by cgk245, Jun 19, 2012
After reading all the posts, all I can say is, " keep on trying to stop the madness that comes with opiate usage.  After four years of various opiates, I too was convinced became an "addict".  It consumed my life, changed my life, killed my brain and caused me more grief than pain relief.  I turned to cortisone injections for lumbar pain, until a neurosurgeon took me under his wing and operated last October.  He lectured me Lon continued use of opiates.  I lost 25 lbs during my addiction, my body was shutting down.  I was living in hell.  Now, I take nothing.  It took four months of gabapentin, flexiral and mental stamina to overcome the cravings.  Let me tell you, I had a cocaine addiction many years ago, I kicked it too.  But, this is something g that overtakes your thinking ability.  I still get cravings, especially now with hip pain, caused from RA.  It is manageable, if you want to get control of your senses again.  
I enjoy life again food, fun, and most of all friends and family.  Reach out to the,, they may be going through the same thing.  
Hope floats.  

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by lostinbenicia, Dec 13, 2012
I can't believe that I somehow stumbled on to this site. I have been reading it for 6 hours now. These stories are so much like my own.I always felt like the Kaiser facility was trying to poison  me! Recently they put me on oxymorphine@$1276 a month!Plus I take morphine, soma, xanax, methadone, norco( took me off lortab),seraquil, celexa, tramadol,klonopin, trazadone, and the list contines as my body has become worse. I started haveing strokes and seizures. this went on for five years. One day I looked in the mirror and my beautiful auburn hair had turn pure white! My son showed my how to use YouTube. Music became my therapy. I bought a couple guitars. Studied Avyuda Eastern medicine and found foods that help pain. Like blueberries, best thing for you. read all I could. Started meditation, yoga.  starting taking myself of the drugs. Weird ,now my hair is turning dark again. But I am still grey, or s&p. Havent been kissed in years.
Thanks so much for relizing that we are out there and despertly need you. The Big Question is,most of us are on disability by now, What is the cost of your facility? Do you have a place for us too? Our kind of insurance?Or is it only for the wealthy? Not trying to be a jerk. Im so sick of being sick.Doctors made me sick.So glad you are putting the word out. Thank you!


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by GG2011gkmn, May 31, 2013
I notice lostinbenicia didn't get a response to his question.

I have checked on the Waismann Method.  I fail to understand how anyone without a multi-million dollar salary is able to pay for this service.  The MINIMUM treatment is $18,000!!!!  That is a year's salary for many people.  Insurance does NOT - I repeat - does NOT pay for this treatment.  Not to mention this facility is located in Beverly Hills - which explains a lot - and patients are required to come to this ONE LOCATION in the ENTIRE country.  

My favorite response from a medical doctor once was, "Well we accept credit cards."  

What about the individual that desperately needs help but can't afford it?  What about them?  

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by jerry11111, Jul 30, 2013
I would like to know how to visit my family in Alabama in the US but my doctor's have me on several Controlled Meds here in my country. I am given by the state in the country where I live: Oxycontin 40mg 5 pills every 8 hours totaling 1000mg of Oxycodode, Also taking Ritalin 10mg 2xs a day, 200mg Modafinil 1x a day, 2mg 3 per day Alprazolam Xanax, 4mg  Flunitrazepam Rohypnol, 6mg 3 per day bromazepam Lexothan, 2mg Lorazepam and 2mg 3 per day of Clonazepam. Of course I don't take all those in the same day just take them as I feel a need to do so. I never usually take 3 full doses a day of any of those drugs with the exeption of the Oxycontin for the uncontrollable pain I suffer from. I just want to be accepted for what ALL my doctors here in my country are all in agreement of the amount of medication I must take, I just want to know where to go and speak to the US before I leave my country to go abroad and visit family. I have letters from all my doctors, the state and the prescriptions as well as the medication and their boxing.

Thanks so very much in advance,

Jerry

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by Mad_Rocker, Oct 13, 2013
I don’t know if this will go through but I feel very strongly about this issue.

I just went through a day of my GP telling me I am a drug addict who is looking for my next hit. This was because I requested an increase to my SR morphine dosage.

I have been on MS Contin for about 2 years for end stage osteoarthritis in both hips. After an unsuccessful right hip replacement in Jun 2012 and a subsequent torn psoas and adductor muscle in Apr 2012 I have been at a baseline pain level of 5/10.

I started at 60 mg twice a day two years ago and have had only a few increases in dosage. I am now just using maximum dosage of acetaminophen in addition to 90 mg of SR morphine. There has been no diagnosis of why there is still pain. I have an orthopedic surgeon who is willing to do an exploratory surgery as nothing shows up on my X-ray.

My GP has diagnosed hyperalgesia. After some research I just do not see it. I get relief every time my dosage is increased but my increases are few and far between. I understand the issue of the hyperalgesia but my GP’s options are to eliminate the morphine and everything will be fine. Trust me.

It’s scary for a chronic pain sufferer to hear that the pain you have is from the morphine that is designed to relieve pain. Question exists: What if my GP is wrong?

Carol B


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by KaiserPutMeUpTheCreek, Oct 23, 2013
My daughter lives with a chronic disease that causes severe pain. Her doc just decided that getting her off of pain meds was the answer to all the problems. We have been members of Kaiser for many, many years.  Since my daughter was first diagnosed at age seven they have completely failed her. Never once have they gotten the disease to go into remission. The treatments they try to give to her are almost worse than the disease itself and have on a number of occassions, almost killed her.  She has a super high tolerance to drugs since she was age 7 and to young to know anything about faking pain in order to get pain meds.  We have asked to go outside of Kaiser for another opinion and have be refused over and over again.  Although, her disease is still active and causing her pain, her doctor has decided that it is all do to hyperalgesia.  Just never mind the chronic disease and the way it has ravaged her body. The doctor never addresses the disease itself, just the pain meds. Is this really an appropriate way to treat patients? My daughter never asks for an increase in pain meds nor does she ask for them early. She is not hypersensitive pain just wants to be able to live with the pain caused by her disease. There was no warning from her doctor about this, just one day she sends an email saying she will no  longer prescribe pain meds......what???  So my daughter has to live with chronic pain because this doctor is afraid of her job at Kaiser.  Afterall, it is about the bottom line and making herself look good to Kaiser.  There is committee that tracks the doctors prescriptions, with no knowledge of the patient's record, and they make all of the doctors run scared.  So this is really what the medical profession has become.  What a sad day for America.

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