Dr. Greg's Blog

Wednesday, July 30, 2014

Unintended Consequences: Pain Killers Amplifying Pain

Most of us at some point in our lives have had the need for a prescription medication of one kind or another. We are familiar with the length of paper which has been carefully and almost comically folded 17 times and included with the drug. On occasion this archaic scroll has been examined, often with great jest, as one squints to read the several page long paragraph in 3 point font. Key phrases may be picked out and shared with others for a good laugh.

Although most people likely ignore it altogether, this list of possible side effects is included with each prescription drug. While our Medical Doctors often do a good job of informing us of potential side effects of the drugs they prescribe, some things do not come to light until a drug has been in use for some time.

One such potential side effect has been increasingly in the spotlight over the past few years, with much thanks to the US’s increased love affair with the pain relieving class of drugs known as opioids. Dependency and withdrawal aside, this recognized potential side effect has the capacity to intensify a person’s pain, putting them in a potentially hazardous position where they may increase their intake of the drug, or combine it with others in an attempt to relieve the pain brought on by the very drug they took to relieve it.

What is an opioid?

Any drug which resembles an opiate, such as morphine, in its effects, and binds to opioid receptors within the nervous system and GI tract is known as an Opioid. Opioids are effective pain killers, but have an addictive nature due to the euphoric effect they may induce. Opioids such as codeine, oxycodone (brand name Percocet), tramadol, methadone and the ever abundant hydrocodone (brand names Norco, Lortab or Vicodin) are commonly prescribed for moderate to severe acute or chronic pain.

Americans love opioids - in 2012 the US consumed 249 million prescriptions of opioids. Of these opioids, hydrocodone is the most common, with 142 million prescriptions filled during 2012 within the United States –accounting for 99% of the world’s use of hydrocodone. With so many prescriptions being filled each year, and 46 people dying each day from opioid overdose, the medical community has been under fire for over prescribing opioids. While short-term use of opioids is certainly warranted in some cases, other solutions for pain management are preferable to long-term use.

Opioids Intensifying Pain: Opioid Induced Hyperalgesia (OIH)

As early as 1870 an increase in pain with morphine use was suggested by the English Physician Thomas Albutt. Well over one hundred years ago Dr. Albutt proposed the question “Does morphia tend to encourage the very pain it pretends to relieve?” Today we can say that Dr. Albutt questioned for good reason.

Opioid Induced Hyperalgesia, or OIH, is the term that has been forged to brand the name of symptoms which may appear to be drug tolerance at first glance. Unlike tolerance, OIH will not respond by taking more drugs, or the response may be spotty. Typically, with OIH the pre-existing pain will be increased, more diffused and less localized. OIH is thought to be able to occur after one large single dose, or prolonged use of opioids as is typically seen in chronic pain patients.

Most patients on opioids such as Hydrocodone for chronic pain are in fact mildly hyperalgesic, most notably to acute pain. This means that any small pain they may have or be subjected to will be amplified and made more generalized or diffuse.

The Bottom Line

With the common use of opioids in our Medical Community for acute and chronic pain it is important for the potential patient to understand that opioids, while often very effective, have the potential to backfire and should be used sparingly. If you are a chronic pain patient and opioid user, consult with your prescribing Physician if you have concerns regarding your opioid use.

Author: Dr. Greg Roberts; Lakeville Chiropractor and owner of Upright Health, with credentials in Corrective Exercise, Graston Technique® and Active Release Techniques®.

1.   Brooks M. Grim stats for opioid-related deaths, prescribing in US. Medscape Medical News [serial online]. July 2, 2014;Accessed July 6, 2014.
2.  Opioid painkiller prescribing: where you live makes a difference. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vitalsigns/opioid-prescribing.
3.  Silverman, S. (2014). Opioid Induced Hyperalgesia. Pain Week Journal, 2 (Q2), 4-19.

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