Opioids and Hyperalgesia

[marachne]

I imagine some of you think I'm crazy over the top w/my cautions about hyperalgesia, but I just saw the following:

Opioid use associated with increased pain sensitivity

Methadone-maintained patients and pain patients treated with methadone and morphine experienced hyperalgesia when exposed to a cold pressor test, placing the nondominant forearm in freezing cold water, but not with electrical stimulation, according to an observational Australian study, involving 40 participants, published in The Journal of Pain . Subjects taking opioids were tested just before a scheduled dose. The investigators did not note allodynia after application of von Frey hairs. The authors concluded that methadone-associated hyperalgesia is not only a phenomenon found with a particular population but reinforces the concept that hyperalgesia, but not allodynia, is associated with the long-term administration of opioids. The authors believe this is the first study to compare pain sensitivity to certain stimuli in chronic pain patients treated with morphine or methadone with methadone-maintained patients or healthy opioid-naïve control subjects. http://www.jpain.org/article/S1526-5900(08)00801-8/abstract Opioid use associated with increased pain sensitivity

Hyperalgesia in Opioid-Managed Chronic Pain and Opioid-Dependent Patients

Justin L. Hay, Jason M. White, Felix Bochner, Andrew A. Somogyi, Tim J. Semple, Bruce Rounsefell

The Journal of Pain - March 2009 (Vol. 10, Issue 3, Pages 316-322, DOI: 10.1016/j.jpain.2008.10.003)

[Whispera, MSN, RN]

I don't think I plan to put anyone's forearm in freezing cold water, with our without electrical stimulation, in or out of hospice....

[marachne]

I'm not suggesting that. All I'm saying is that long-term opioid use can lead to hypersensitivity to pain, and that sometimes titrating up on the same med can actually make pain worse, not better.

Here's the money line: "reinforces the concept that hyperalgesia, but not allodynia, is associated with the long-term administration of opioids."

I'd link the whole article, but I'm not sure if that violates fair use -- I have access to it b/c of a membership or subscription.

[heron, ASN, RN]

I've seen situations where hyperalgesia might be the problem ... we usually got a grip by changing opioids and simplifying the regimen.

Did the article come up with any ideas on how to avoid or deal with the problem?

[marachne]

I've seen situations where hyperalgesia might be the problem ... we usually got a grip by changing opioids and simplifying the regimen.

Did the article come up with any ideas on how to avoid or deal with the problem?

Heron, the article's focus was on comparing methodone and other opioid-users (for chronic pain)'s hyperalgesia profile, so no, there were no suggestions made. I also decided that I could share the article. It's pretty technical and dry, and not specifically related to end-of-life (except in the case that we often are dealing with people who have been on some kind of pain management for a long time).

Hay Hyperalgesia.pdf

[heron, ASN, RN]

Thanks, Marachne.

[mc3, ASN, RN]

I don't think I plan to put anyone's forearm in freezing cold water, with our without electrical stimulation, in or out of hospice....

My thoughts, exactly.

mc3 :paw: