Hyperalgesia

http://suicideproject.org/2015/08/can-people-in-chronic-pain-be-prescribed-morphine/

August 25th, 2015 by wndozh8er

just curious if doctors would prescribe morphine tablets to people with severe and incurable chronic pain?

Somebody Insignificant
AUG 25, 2015
The old thought was that your body adapts to the morphine so you need more and more the longer you are on the drug. For people who have chronic pain this means that Doctors had to keep increasing their dosage.

So now the new thought is that our bodies don’t get used to the morphine. The morphine actually sensitizes your body to pain so that the longer you have been taking morphine and at increasing doses you are making your body more sensitive to pain. This allows the Doctors to tell yo that you need to stop taking morphine and eventually your body will return to normal and will not be so sensitive to pain so you will not need pain meds and wont be in any pain at all…

I guess the commenter is speaking of the theory of hyperalgesia. There are doctors who believe in hyperalgesia (even though no one can say how prevalent it is), and I guess they’ve convinced some patients, too. But I still wonder if it exists.

One way to treat it is by reducing or stopping opioid use, but it’s also treated with rotation of the medications. However, expecting to be pain free after reducing or stopping opioid treatment would be something akin to magic. It’s not like the pain that existed before this alleged hyperalgesia condition is going anywhere.

http://www.amepc.org/apm/article/view/466/536

(2012) Opioid-induced hyperalgesia: What to do when it occurs?

Opioid-induced hyperalgesia has been defined as increasing pain sensitivity in patients chronically exposed to opioids without any evidence for new causes of pain…

That doesn’t make sense. A patient “chronically exposed to opioids” would be a chronic pain patient. Chronic pain doesn’t get better; it just gets worse. So looking for evidence of “new” causes of pain isn’t even necessary. And it’s confusing why increased pain would always mean a new cause, otherwise you’re suffering from hyperalgesia or drug addiction. Aren’t all the old causes (and old age) enough evidence of increased pain, or do patients have to continually prove their pain levels with new medical conditions?

While the phenomenon has been well studied in many animal experiments subsequent to this first description, there is ongoing debate about the clinical relevance of this phenomenon, exemplified by the title of a most recent review “Opioid induced hyperalgesia: Clinically relevant or extraneous research phenomenon?”