4.2 Clinical Evidence
Similar to basic science evidence, supporting clinical evidence has also been established (14,21,30,43-55). Clinical OIH has been described after intraoperative remifentanil infusion (30), in patients with detoxification from high dose opioids with improvement in pain (43), and increased pain sensitivity with methadone (21).
…6.4 Practical Considerations
The treatment of OIH can be time-consuming and at times, impractical. Weaning patients from high dose opioids usually requires time and patience (for both the physician and patient). While reducing the opioid dose, patients might experience transient increases in pain or mild withdrawal which can exacerbate pain. The hyperalgesic effect might not be mitigated until a certain critical dose of opioid is reached.
(21) Compton P, Charuvastra VC, Ling W. Pain intolerance in opioid-maintained former opiate addicts: Effect of longacting maintenance agent. Drug Alcohol Depend 2001; 63:139-146.
(43) Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high dose opioids. J Opioid Manag 2006; 2:277-282
(45) Hay JL, White JM, Bochner F, Somogyi AA, Semple TJ, Rounsefell B. Hyperalgesia in opioid-managed chronic painand opioid-dependent patients. J Pain 2009; 10:316-322.
(47) Fishbain DA, Cole B, Lewis JE, Gao J, Rosomoff RS. Do opioids induce hyperalgesia in humans? An evidence-based structured review. Pain Med 2009; 10:829-839.
(48) Mitra S. Opioid-induced hyperalgesia:Pathophysiology and clinical implications. J Opioid Manage 2008; 4:123-130.
(49) Cohen SP, Christo PJ, Wang S, Chen L, Stojanovic MP, Shields CH, Brummett C, Mao J. The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus. Reg Anesth Pain Med 2008; 33:199-206.
There appears to be some connection with withdrawal and experiencing the sensation of pain. According to the above, continued opioid use has the capacity to increase the level of pain a subject experiences.
So…. when we are giving pain medicine recipients turn opioid dependent people more opioids, like methadone, wouldn’t it follow that we -in effect- worsening the pain problem they had originally? …And the longer they are on opioids, the worse their pain situation and the further into addiction they are sent?