Many of you may have this question run through your mind
everyday. Why is my patient overly
sensitive to pain? Why does a simple IV start inflict anxiety? Why does the
patient complain of not being sedated enough during their procedure? Although
there are many factors that can play into each of these scenarios, one of the
answers may be a condition called Opioid induced hyperalgesia. The condition is exactly what it states to
be; increased pain that is induced by chronic use of opioids.
OIH is “characterized by a paradoxical response
whereby a patient receiving opioids for the treatment of pain could actually
become more sensitive to certain painful stimuli” (Lee, et. al, 2011). The type of pain the patient experience is
not necessarily more of the type of pain they originally had. Basically what is happening here is that the
pain receptors in the body become more sensitive thereby making pain more
painful. Make sense? It does to me. If I
am taking a medication that is silencing my pain receptors so I don’t feel
pain, my body is so amazing that it recognizes that it needs to work harder to
ensure that I am able to feel pain more so I can protect myself.
This is an
interesting but frustrating phenomenon that has been studied by many doctors.
In fact, the first doctors that noticed and wrote about this condition were in
the late 1800’s. Albutt in 1870 stated “At such times I have certainly felt it
a great responsibility to say that pain, which I know is an evil, is less
injurious than morphia, which may be an evil...Does morphia tend to encourage
the very pain it pretends to relieve” (Lee, et. al, 2011)
Treatment options: According to PubMed, the treatment for
OIH is to reduce the opioid dosage by tapering them off. As you know, many
patients do not like this! Probably because there is a lack of education and
the patient does not understand the dangers of opioids. Obviously, just reducing the pain medications
is not going to fix the patient. The
patient needs to be educated regarding other pain management options. This could include alternative therapies such
as acupuncture, physical therapy, chiropractic care or steroid injections,
nerve blocks and ablation therapy.
Whats a nurse to do? As a nurse, we are not able and do not
have the education to diagnose patients.
What we can do, is understand that this is a condition that some of our
patients may deal with. We have patients
that come from various backgrounds and situations. Unless we walk a mile in their shoes, we
cannot being to understand the pain(physical and emotional) that they have been
through. When it might be easy to judge,
we can shift our attitude to understanding.
Most of our patients just need some TLC! Having more patience with our
patients can go a long way.
More information about OIH:
Reference:
Lee, M., Silverman, S.M., Hansen, H., Patel V.B.,
Manchikanti, L. (2011). A comprehensive review of opioid-induced hyperalgesia.
Pain Physician, 14(2), 145-161. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21412369.
