From Pain Medicine News, January 2014:
You would think that if you stubbed your toe you wouldn’t intentionally stub it more often, and harder, expecting it to relieve the pain, it would get worse. But you also wouldn’t think that taking more of a narcotic to treat pain would make it worse, but it may for many. This effect, opioid-induced hyperalgesia, is a very real problem that adversely affects the lives of many who suffer from chronic pain. And to show how significant of a problem it is, but also how you can resolve this problem, a poster session at Pain Week 2013 in Las Vegas outlines a brief study showing how to improve pain by taking lower daily-doses of opiates. The leading researcher, Raj Kalra, MD, medical director, Chronic Pain Management Program, Kaiser Permanente Greater Southern Alameda Area, Union City, Calif., found the following from their narcotic dose-reduction study.
- Sixteen patients were tapered over an average of 17.4 weeks from a daily morphine equivalent of 945 mg (range, 300-2,960 mg) to 275 mg (range, 0-750 mg)
- Their average pain score on the Brief Pain Inventory fell from 7.2 to 4.9
- Their average depression score on the Patient Health Questionnaire-9 dropped from 13.5 to 9.5
- The patients benefited from the tapering: Their average pain was reduced, as was pain interference in their quality of life, particularly in activities of daily living
- Eighty percent of the patients had withdrawal symptoms. The most common symptoms were anxiety, sweating or chills, muscle cramps, aches or spasms, tremors and insomnia. No significant complications were noted
The article quotes Dr. David Juurlink, an expert in the toxicology of opiates, “This is exactly the sort of research that needs to be replicated,” said Dr. Juurlink. “There is a huge swath of the North American population taking very high doses of opioids yet continuing to suffer. In some cases, their pain gets worse as the dose increases. This approach perhaps could help many of them.”
So when the pain gets worse as the dose of narcotic goes up, it’s time to consider that you’re stubbing your toe even harder so consider backing off! Talk with your doctor to find out if you may benefit form this approach to managing difficult to treat pain syndromes.