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Opioid-induced Hyperalgesia

Opioid-induced hyperalgesia, or OIH, is a problem that sometimes occurs with long-term, high-dose opioid use where an opioid paradoxically creates a higher sensitivity to pain. OIH is often mistaken for tolerance. The two conditions are often difficult to distinguish because clinical pain evaluation typically relies on a one-to-ten scale, which doesn’t distinguish between kinds of pain. Consequently, doctors and patients usually assume the patient has developed a tolerance to the opioid, allowing the original pain to return.

In reality, OIH is a completely different mechanism that is not yet well understood. It seems opioids can interfere with the brain’s ability to inhibit pain signals. The distinction can be important because tolerance and OIH are treated differently in chronic pain patients. While patients actually experiencing tolerance can simply be treated with an increased dose–which is a bad idea for addicts–OIH is typically treated with a reduction in dose, and sometimes with a change or addition in medication. If the patient is suffering from OIH, a reduction in dose should reduce the pain.

There are a few indications that a patient may be experiencing OIH instead of tolerance. One indication is increased tactile sensitivity. That is, normal touches may be amplified or even painful. Another indication is if the intensity of the original pain actually increases without cause. The injury doesn’t get worse, but the pain does. This can be harder to gauge because the pain will likely have been muted for a long time when the opioids were working properly and it is hard to accurately compare a distant pain to a current one. A third indication may be more useful: the area of the pain has spread despite the area of the injury remaining the same.

People struggling with opioid addiction should know about OIH because many of those people were originally prescribed opioids to manage chronic pain. They may have had their dosage increased when the pain increased, which may have been appropriate for tolerance, but not for OIH. If someone started taking opioids he wasn’t prescribed–as happens often– or switched to heroin, he wouldn’t so much as consult with a doctor before increasing his dose. He may be trying to treat pain with a drug that makes the pain worse.  

Awareness of OIH can prevent unnecessary escalation of dosage in chronic pain patients. It can also be one more reason get treatment for opioid addiction, if there aren’t enough reasons already. If you or someone you love is struggling with opioid addiction, Gardens Wellness Center can help. We offer medically assisted detox to make withdrawal as painless as possible and we also offer a number of non-opioid treatments for chronic pain. Call us today at 844-828-1050 or email us at to learn more.