Opioid Pain Relievers Can Make Pain Worse In Some Patients

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Opioid Pain Relievers Can Make Pain Worse In Some Patients

http://www.medicalnewstoday.com/articles/118746.php

Opioid medications are essential for helping to relieve all types of

serious pain. However, relatively recent evidence suggests that in

some patients they can paradoxically worsen the pain.

" Actually, this possible negative effect of opioids, such as

morphine, to cause increased sensitivity to pain was observed in the

19th Century, " says Peggy Compton, RN, PhD. " Today, we call this

opioid-induced hyperalgesia, or OIH. "

Compton is an Associate Professor of Nursing at the UCLA School of

Nursing, Los Angeles, and a well-known researcher and author in the

pain management field. Her extensive review of the clinical evidence

on OIH, exclusively for Pain Treatment Topics and published at the

Pain-Topics.org website, is titled " The OIH Paradox: Can Opioids Make

Pain Worse? "

Fortunately, it seems that OIH does not arise in the majority of

patients taking opioid analgesics, but when it does occur it can be

difficult to manage. In addition to OIH, pain increasing during

opioid therapy can indicate several other conditions that must be

considered, including: 1) worsening pain-causing disease, 2)

tolerance to opioid effects, 3) opioid withdrawal symptoms, or 4)

pseudoaddiction (opioid-seeking due to unrelieved pain). For these

conditions, increasing the opioid dose usually helps relieve pain.

A patient who is addicted to opioids may complain of worsening pain

but may not be helped by increasing the opioid dose. In fact, signs

of addiction may emerge further, such as difficulty controlling

opioid use, a preoccupation with obtaining opioids, or other

misbehavior.

In the case of OIH, increasing the opioid dose will actually make the

pain worse. Often, the pain is difficult for the patient to describe

and can spread beyond the original point of pain. According to

Compton's review, several strategies may help prevent OIH or to deal

with OIH if it occurs:

-- The opioid dose should be kept as low as is clinically effective

for managing pain.

-- Additional medications can be used to help minimize the need for

opioids, such as COX-2 inhibitors, dextromethorphan, and others.

-- Long-acting opioids are preferred over shorter-acting formulations

for chronic pain.

-- If a particular opioid becomes ineffective, it is often helpful to

rotate to a completely different opioid drug (methadone is especially

useful for opioid rotation).

-- New research suggests combining low-doses of opioid antagonists

(eg, naltrexone) with opioid therapy to counteract development of OIH.

Compton observes that there are still many unanswered questions about

OIH, and research investigations are ongoing. Meanwhile, it is

essential for healthcare providers to carefully monitor patients'

responses to opioid therapy and recognize that several opioid-related

responses other than OIH can lessen opioid-analgesic effectiveness.

In some cases, higher dosing is needed; however, if OIH occurs, other

strategies should be employed to provide patients the pain relief

they need and deserve.

Pain Treatment Topics and the associated Pain-Topics.org website

provide open and free access to noncommercial, evidence-based

clinical news, information, research, and education on the causes and

effective treatment of the many types of pain conditions. It is

independently produced and currently supported by an unrestricted

educational grant from Covidien/Mallinckrodt Inc., St. Louis, MO, a

leading manufacturer of generic opioid analgesic products.

Pain Treatment Topics

202 Shermer Rd.

Glenview, IL 60025

United States

http://Pain-Topics.org