Opioid Induced Hyperalgesia

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:

Medscape- Opioid-Induced Hyperalgesia

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.