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Hyperalgesia [Heightened Pain Sensitivity] in Opioid-Managed Chronic Pain and Opioid-Dependent Patients - Source: Journal of Pain, Mar 2009

  [ 55 votes ]   [ 4 Comments ]
By Justin L Hay, et al. • • March 24, 2009

[Note: of all people with chronic pain (up to 15% of the U.S. population), as many as 5% have severe pain treated by opioids.]

This observational study aimed to determine whether pain sensitivity in patients with noncancer chronic pain, taking either methadone or morphine, is similar to patients maintained on methadone for dependence therapy, compared with a control group [“opioid naïve”].

Nociceptive thresholds were measured on a single occasion with von Frey hairs, electrical stimulation, and cold pressor tests. In all subjects receiving methadone or morphine, nociceptive testing occurred just before a scheduled dose.

• Cold pressor tolerance values in patients with noncancer, chronic pain, treated with morphine and methadone, were 18.1 ± 2.6 seconds (mean ± SEM) and 19.7 ± 2.3 seconds, respectively;

• In methadone-maintained subjects it was 18.9 ± 1.9 seconds,

• With all values being significantly (P < .05) lower than opioid-naïve subjects (30.7 ± 3.9 seconds).

These results indicate that patients with chronic pain managed with opioids, and methadone-maintained subjects, are hyperalgesic [feel more pain than normal from painful stimulus] when assessed by the cold pressor test but not by the electrical stimulation test.

None of the groups exhibited allodynia as measured using the von Frey hairs. These results add to the growing body of evidence that chronic opioid exposure increases sensitivity to some types of pain. They also demonstrate that in humans, this hyperalgesia is not associated with allodynia [normally non painful stimuli elicit pain sensation].

Perspective: This article presents an observational study whereby the pain sensitivity of patients with chronic pain managed with opioids, and opioid-maintained patients, were compared with opioid-naïve patients. The results suggest that opioid use may contribute to an increase in the sensitivity to certain pain experimental stimuli.

Source: Journal of Pain, Mar 2009;10(3), 316-322. PMID: 19101210, by Hay JL, White JM, Bochner F, Somogyi AA, Semple TJ, Rounsefell B. Discipline of Pharmacology, Medical School North, University of Adelaide, SA, Australia. [E-mail:]

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Article Comments Post a Comment

well DUH
Posted by: Svette_Palme
Mar 29, 2009
Yes, I think this is a certainty. In fact, I thought it was well known, for decades, since the Civil War era. You see, morphine depletes the normal pain-dampening chemistry of the brain and CNS. The exact brain chemicals involved, I am not sure of, probably something to do with seritonin? No, I cannot remember now. Anyway, because morphine PROVIDES them, the brain stops producing them. I think this is the basis of withdrawal pains too. I am a long-term [prescribed] opiate user, originally prescribed for chronic pain. I am not so sure that I would recommend this therapy, but I was willing to try anything 18 years ago, and I made it this far so I guess it helped. I was so naive at the time... under prohibition conditions it can be sheer hell being addicted to opiates. I do have heightened pain sensitivity, but I had that all those years ago too... maybe people who are on morphine are going to be that way in the first place... did this study take that into account?
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it may not be the opioids
Posted by: moppetage
Apr 1, 2009
Given any long term severe pain will itself over sensitise the nervous system and that it's not disclosed if the non opioid group were chronic pain sufferers it may have nothing to do with opioids. If you have severe pain for long enough your nervous system starts to transmit non-painful stimuli as being painful. Anything that puts your body under significant stress can do that too (say if you're taking methodone for addiction). Also this seems to give yet another reason for doctors to avoid prescribing morphine etc in cases of severe chronic, non cancer pain. When it comes down to it who cares if your tolerance to other pain decreases a little if the drug has damped down the problematic pain to a level that gives you some quality of life. I've been on the same level of slow release morphine for around 7 years now due to chronic spinal pain after a fracture that caused disc intrusion to the spinal cord. I've found less side effects with this drug then I have with any of the many others I tried first. I've not noticed my pain tolerance decrease although I don't cope as well emotionally as I used to. I believe that if the quality of life is severely impaired due to severe pain everybody should at least have the option of opiates if nothing else has worked.
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Chronic pain treatment
Posted by: meedmo42
Apr 1, 2009
Since I have Fibromyalgia and had six years of being incapacitated with severe pain, I now take a muscle relaxant and generic tylenol or vicodin. I took vicoprofen before I had my blood pressure meds changed. I limit the pain reliever to times when I feel the pain more, so that it doesn't get to the point where I am down with it. As long as you are not taking it just to "feel better emotionally" (and you can ask yourself that question), it is more an addiction to living with less pain where you can function in a fairly normal life. Have had this for the last 30 years and have not increased the amount I take. Pain prevention is of the essence for people with Fibro if you want to carry on with life. Have never taken Morphine, but if my pain reliever ever began to fail me, I would definitely consider anything that keeps me on my feet and moving.

Mary E.


I also am on Long Term opioid pain management
Posted by: mamacat
Apr 1, 2009
I have reservations about this article as well. I also agree with poster #2 about being more emotional but my PM Dr. tells me that chronic daily pain at the level I deal with if not treated by some means that gives me an improved quality of life, causes all kinds of different issues! I am on Extented Release Morphine and have also taken Methadone for actual pain management as well. I find that the morphine procducts work best for me and Methadone caused elevated blood pressure and heart palpitations among a few other side effects I couldn't tolerate after a while on it. I also have Fibromyalgia, Post Polio Syndrome, Neuropathy pain and degenerative disc and joint disease......I am never out of pain even with the Morphine and the Fibro and and other health issues also cause heightened pain sensitivity. I think we need more positive information about the benefits of Opioid pain management out there as it certainly has been the "Only" thing that has helped me and I have had very negative comments made to me by Dr's and other medical professionals about being on Opioids and have felt like they look at me like I'm an abuser without even knowing my medical history or the fact that I treated my disabilities and pain with every other conceivable method known to man before I finally gave in to Opioid Pain Management as my only hope of a partially functional life. Do I like it? No! Do I wish I didn't have to take them? Yes! Does it make me a bad person or a weak person? Not at all! So let's hear something positive and upbuilding about Opioid Therapy the oldest and safest Drugs of all time instead of them trying to find reasons why we shouldn't take them!!! The medical profession never had a problem using them 30 years ago but now it seems because people have started abusing them because of easier availability "We" The Chronic Pain patients of the world must now suffer under all kinds of stereotypes and ill treatment for using what was always considered a good and effective remedy in the past and no one raised a fuss! I'll now step down off my soapbox as I could go on and on over this issue! Foe me to agree with this articles author I'd have to see alot more information included in his study!!
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