What Is Opioid-Induced Hyperalgesia?

Prescription opioids are commonly used for chronic pain patients to treat neuropathic pain, non-cancer pain, and postoperative pain.

Opioids work by attaching to nerves in the body called opioid receptors. This will decrease the pain messages sent to the brain and central nervous system and create an analgesic effect.

After prolonged use of opioids, some people may experience the onset of a condition called opioid-induced hyperalgesia (OIH).

OIH occurs when opioid medications worsen rather than decrease the pain that they are designed to alleviate. People taking opioids for pain will report their pain getting progressively worse when OIH is a potential diagnosis.

When pain sensitivities start to develop, a person may begin to feel new pains in other areas of the body, or experience acute pain from minor injuries.

What Causes Opioid-Induced Hyperalgesia?

The causes for OIH are not always known, but it’s generally agreed that opioids can produce a reaction in the nervous system called hyperactivation.

Hyperactivation is the opposite of blocking pain signals, and will lead to an increase in the pain a person is feeling.

Research shows that the reaction can happen after a few doses, but in most cases it is seen in people who have taken high doses of opioids over a long period.

Symptoms Of Opioid-Induced Hyperalgesia

Most people with OIH will experience a similar set of symptoms.

Symptoms of OIH include:

• pain intensity increases while the underlying medical condition remains the same
• the pain radiates further from the original location of the pain
• the quality of the pain (i.e. burning or stabbing) may be difficult to define
• the development of new pain without a new diagnosis
• extreme sensitivity to otherwise benign stimulation (i.e. softly touching the skin)

It’s important to differentiate OIH and opioid tolerance. Tolerance refers to a decreased effect of the medication after repeated use, which requires a higher dose to reach the intended effect.

If people with OIH are given a higher dose of opioids to treat their condition, it’ll likely make their symptoms worse.

Treatment Options For Opioid-Induced Hyperalgesia

Oftentimes, clinicians may gradually reduce opioid therapy or remove a patient from opioid treatment entirely if they are having OIH symptoms.

To help with pain management, people may be given a different regimen of painkillers including NSAIDs, acetaminophen, or antidepressants. Sometimes, methadone is used in an opioid rotation to taper people off the drug.

Treatment Services For Substance Use Disorders

The onset of OIH does not indicate someone has an addiction to opioids. However, substance abuse can occur due to the chronic pain that people feel they need to resolve with high doses of other types of pain medication.

If you or someone you care about has a substance use disorder, help is available through evidence-based treatment services.

Treatment options for drug addiction may include:

• medication-assisted treatment (MAT) using buprenorphine
• support groups for opioid dependence
• medically supervised detoxification
• counseling services
• dual diagnosis care for co-occurring disorders
• outpatient our residential care
• aftercare

When prescription opioids don’t seem to be helping with pain relief, or are contributing to increased pain, it’s important to talk to your healthcare provider promptly.

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Call our helpline today for more information on substance abuse or issues related to chronic opioid use. Our team can assist you in finding a treatment provider in your area.

Written by the Addiction Resource Editorial Staff