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Rich66 · 12-28-2009, 10:12 PM

12.28.2009
Pain Medication May Increase the Symptoms of Chronic Pain
LINK
By Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II
Over the past twenty seven years I have worked with many people taking opiate medications who develop a condition known as opioid-induced hyperalgesia. For those of you unfamiliar with this phenomenon here is the definition of opiate-induced hyperalgesia from Wikipedia. Opioid-induced hyperalgesia or opioid-induced abnormal pain sensitivity is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, Oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.
If an individual is taking opioids for a chronic non-cancer pain condition, and cannot achieve effective pain relief despite increases in dose, they may be experiencing opioid-induced hyperalgesia. In this case, they may benefit from complete withdrawal from opioid therapy. Many individuals report reduced pain levels when opioids are withdrawn.
When people are undergoing chronic pain management they want help stopping or relieving their pain symptoms. What they may not realize is that some pain medications can actually cause or increase the pain that they are using the medication to manage. That is why it is crucial for people undergoing chronic pain management to educate themselves and learn as much as possible about their chronic pain condition as well as the most effective treatment options.
For example many people experiencing frequent headaches, especially migraines, do not realize that the medication they are using can actually be increasing the frequency and even severity of their pain. The use of opiates to treat migraines can lead to an increased risk for what is called transformed migraines. Transformed migraines are chronic, daily headaches with a vascular quality — meaning that they are throbbing in nature.
As anyone who ever experienced a migraine headache knows it can be extremely debilitating. Unless a migraine sufferer goes to a treatment provider who understands appropriate treatment interventions for this condition, they can run the risk of unnecessary pain and suffering including transformed migraines or even potential prescription drug addiction. Many people are prescribed opiates even though they are not an FDA approved medication for migraine treatment.
Long-term use of opioids to manage other chronic pain conditions also increases patients’ sensitivity to certain types of pain, and similar hyperalgesia develops with methadone-maintained drug abusers as researchers from the University of Adelaide, in Australia, report. This observational study by Justin L. Hay, MD, and colleagues was posted is in the March 2009 issue of the Journal of Pain.
David Clark, MD, from the Palo Alto VA Health Care System, in California, has also studied opioid-induced hyperalgesia and adds his comments regarding this study. According to Dr. Clark, "An important finding in this study was that not only addicts have this type of sensitization. Chronic-pain patients have it as well, so this problem goes beyond the boundaries of what is unique to drug abusers."
Dr. Clark said the finding that long-term use of opioids seems to sensitize patients to pain itself suggests factors that could both limit the clinical utility of opioids used to control chronic pain and add to pain problems in those being treated for addiction. “The emerging experience regarding the long-term use of opioids for chronic pain is not terribly encouraging, and opioid-induced hyperalgesia is one explanation for why this therapy might have limited success,” he said.
The evolving need of people undergoing chronic pain management for safe, effective pain relief is driving research into new therapeutic modalities and fresh approaches to familiar treatments. New innovations involving both opioid and nonopioid pain modalities as well as nonpharmacological approaches are vital because some patients fail to achieve a good outcome with opioid therapy alone.
That is why nonopioid medications and non-medication type interventions are receiving greater research attention. Opioids are also the subject of new exploration, most of this directed toward separating desired analgesia from unwanted side effects such as euphoria, tolerance, abuse risk, addiction and constipation.
To learn more about effective chronic pain management please check out our Addiction-Free.Com Website. Be sure to review the Articles and the News and Research pages for free information and patient education.

12-28-2009, 10:12 PM	#5
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Re: Opiates/Opioids 12.28.2009 Pain Medication May Increase the Symptoms of Chronic Pain LINK By Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Over the past twenty seven years I have worked with many people taking opiate medications who develop a condition known as opioid-induced hyperalgesia. For those of you unfamiliar with this phenomenon here is the definition of opiate-induced hyperalgesia from Wikipedia. *Opioid-induced hyperalgesia* or opioid-induced abnormal pain sensitivity is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, Oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids. If an individual is taking opioids for a chronic non-cancer pain condition, and cannot achieve effective pain relief despite increases in dose, they may be experiencing opioid-induced hyperalgesia. In this case, they may benefit from complete withdrawal from opioid therapy. Many individuals report reduced pain levels when opioids are withdrawn. When people are undergoing chronic pain management they want help stopping or relieving their pain symptoms. What they may not realize is that some pain medications can actually cause or increase the pain that they are using the medication to manage. That is why it is crucial for people undergoing chronic pain management to educate themselves and learn as much as possible about their chronic pain condition as well as the most effective treatment options. For example many people experiencing frequent headaches, especially migraines, do not realize that the medication they are using can actually be increasing the frequency and even severity of their pain. The use of opiates to treat migraines can lead to an increased risk for what is called transformed migraines. Transformed migraines are chronic, daily headaches with a vascular quality — meaning that they are throbbing in nature. As anyone who ever experienced a migraine headache knows it can be extremely debilitating. Unless a migraine sufferer goes to a treatment provider who understands appropriate treatment interventions for this condition, they can run the risk of unnecessary pain and suffering including transformed migraines or even potential prescription drug addiction. Many people are prescribed opiates even though they are not an FDA approved medication for migraine treatment. Long-term use of opioids to manage other chronic pain conditions also increases patients’ sensitivity to certain types of pain, and similar hyperalgesia develops with methadone-maintained drug abusers as researchers from the University of Adelaide, in Australia, report. This observational study by Justin L. Hay, MD, and colleagues was posted is in the March 2009 issue of the Journal of Pain. David Clark, MD, from the Palo Alto VA Health Care System, in California, has also studied opioid-induced hyperalgesia and adds his comments regarding this study. According to Dr. Clark, "An important finding in this study was that not only addicts have this type of sensitization. Chronic-pain patients have it as well, so this problem goes beyond the boundaries of what is unique to drug abusers." Dr. Clark said the finding that long-term use of opioids seems to sensitize patients to pain itself suggests factors that could both limit the clinical utility of opioids used to control chronic pain and add to pain problems in those being treated for addiction. “The emerging experience regarding the long-term use of opioids for chronic pain is not terribly encouraging, and opioid-induced hyperalgesia is one explanation for why this therapy might have limited success,” he said. The evolving need of people undergoing chronic pain management for safe, effective pain relief is driving research into new therapeutic modalities and fresh approaches to familiar treatments. New innovations involving both opioid and nonopioid pain modalities as well as nonpharmacological approaches are vital because some patients fail to achieve a good outcome with opioid therapy alone. That is why nonopioid medications and non-medication type interventions are receiving greater research attention. Opioids are also the subject of new exploration, most of this directed toward separating desired analgesia from unwanted side effects such as euphoria, tolerance, abuse risk, addiction and constipation. To learn more about effective chronic pain management please check out our Addiction-Free.Com Website. Be sure to review the Articles and the News and Research pages for free information and patient education. __________________ Mom's treatment history (link)