Opioid-Induced Hyperalgesia

Hyperalgesia is an increased sensitivity to pain. Opioid-induced hyperalgesia can occur after someone has been exposed to high doses of opioids for an extended period of time. The medications that are supposed to relieve pain can make pain worse.
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People who develop opioid-induced hyperalgesia can feel pain from sources that don’t normally cause discomfort. The pain these people experience is typically unusually severe.

Prescription opioids, such as morphine, hydrocodone and oxycodone, are effective medications for short-term pain relief. But no studies show the drugs are effective for long-term use. In some instances, long-term opioid use can have a reverse effect.

The medications can change the way nerves respond to pain. Experts aren’t sure exactly how opioids cause increased sensitivity to pain, also known as hyperalgesia. They also don’t know how common the condition is. But many experts believe opioid-induced hyperalgesia plays a key role in the treatment of pain and the development of opioid addiction.

What Causes Opioid-Induced Hyperalgesia?

We don’t fully understand what happens inside the body to cause hyperalgesia. Experts believe hyperalgesia occurs when nerves that regulate pain miscommunicate. Opioids may disrupt the way nerve cells function, according to a 2011 review published in the journal Pain Physician.

Hyperalgesia seems to be associated with long-term opioid use and high doses of opioids. Reports of hyperalgesia after short-term or low-dose opioid use are less common but have occurred.

The condition is also associated with tolerance. Tolerance occurs when the body requires higher doses of a substance to feel an effect. It’s a common adaptation that develops in every person who repeatedly uses opioids.

Hyperalgesia doesn’t appear to affect every person, but it seems to be more common among people who have a high tolerance. Some experts believe genetic factors influence whether a person develops hyperalgesia, but the specific genetic factors aren’t known.

Symptoms of Opioid-Induced Hyperalgesia

Opioid-induced hyperalgesia can be difficult to diagnose because multiple factors can make pain more severe while a person is taking opioids. An injury or disease can worsen. A new source of pain may be introduced.

Hyperalgesia may be mistaken for opioid withdrawal symptoms. It can also be mistaken for tolerance. As tolerance develops, pain is expected to return. But symptoms of hyperalgesia can differ from pain caused by an injury or illness.

Symptoms of hyperalgesia include pain that is:

  • Long-lasting
  • Decentralized
  • Difficult to define

Experiencing pain from a source that doesn’t usually cause pain is a warning sign for hyperalgesia. Pain from the condition often occurs in areas other than the original site of pain. Feeling pain in a new part of the body without an apparent cause may be a warning sign for opioid-induced hyperalgesia.

Increasing the dose of an opioid is the standard response to tolerance, but higher doses of opioids make hyperalgesia worse. Doctors can diagnose hyperalgesia if a person experiences more pain after taking a higher dose of an opioid.

Treatment & Recovery from Hyperalgesia

Discontinuing opioid use is the primary treatment for hyperalgesia. Doctors can also change the type of opioid the person is taking or prescribe a non-opioid pain medication.

Quitting an opioid can be difficult if the person has developed tolerance because withdrawal can occur. Doctors gradually wean patients off opioids to limit the severity of withdrawal. The person may experience pain during this process, but this pain should lessen as the body recovers from hyperalgesia.

People who are still in pain because of an injury or illness may benefit from methadone or buprenorphine, according to a 2015 review published in the journal Pain Medicine. Doctors prescribe these long-acting opioids to relieve symptoms of hyperalgesia caused by other opioids. However, methadone and buprenorphine aren’t always effective.

Other types of medications, such as anticonvulsants and antidepressants, may also relieve specific types of pain. Surgical procedures and behavioral management are also options.

Recovery from opioid-induced hyperalgesia can take time. The duration of recovery is affected by length of opioid use, severity of symptoms and personal factors. No standard timetable exists, but most people recover from the condition.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer, DrugRehab.com
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.
Kim Borwick, MA
Editor, DrugRehab.com

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