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Opiod Induced Hyperalgesia

Vicky ODonnellVVicky ODonnell Posts: 25
edited 06/11/2012 - 8:35 AM in Chronic Pain
Has anyone else ever been diagnosed with Opiod Induced Hyeralgesia?
I am completely burned out with never ending pain. I have been directed to a new Pain Management Facility and was told I have this from taking meds for so long. I am scared to death to ween off the Vicodin but the diagnosis sounds very accurate. My concern is what will I do with the daily pain I suffer. It is a catch 22. Nerve damage has a lot to do with this and the increased pain I have. At this point,functoning on a daily basis is beyond my control. I have heard that there are non-addictive pain pumps that can help immensley but no one seems to know what the name of them are? Does anyone or has anyone ever had such a type of pain reliever? A lot of my challenges are the muscles, ligaments and tendons that connect to the lower back. Having relied on these drugs to help me exists has caused great depression not to mention my inability to work. I am exhausted emotionally and physically beyond measure and just want my life back.. My family is convinced I need to go into the hospital to withdraw from the medication.

Above everthing else going on and dealing with the excrutiating pain I endure everyday, the last thing I want to have to do is get off the only med that at the very least helps my "function".


  • I have lived with pain so long it is hard to imagine life without pain anymore. I have not heard of this pain pump but am interested in learning more about it myself.

    I hope you find relief soon, and I will be praying for you on your quest for pain relief and gaining your life back.

  • Honestly, If I was fused from L1 to S2, taking Vicoden, and my doctor even approached the topic of opioid induced hyperalgesia.... I'd be looking for a new doctor.

    Are you seeing a pain management specialist? Or are you still being bounced around by surgeons and GP's?

  • Well, it's time to find a new spinal specialist when the old one tells you there is nothing more he can do for you. Do not give up. Look for a fellowship-trained spinal specialist that specializes in failed back surgery syndrome, or spinal reconstruction. You may have to hunt a bit to find someone that will take on your case...maybe go to a bigger city or a university teaching hospital...but you can find someone to at least get another opinion from.

    Have you tried going to a psychologist that specializes in chronic pain syndrome, or whatever it is called? There are also some excellent CDs that provide meditations for chronic pain, and teach you exercises to help deal with it. They are nice to have so you can plug in whenever you need a break.

    You also might benefit from massage therapy and body work IF you can find a person very knowledgeable in orthopedic cases. Again locating the right person is so important.

    Are you taking one of the antidepressants (the SNRIs like Cymbalta or Effexor) that also is given for pain? Those can also help aid the depression/chronic pain cycle.

    I'm sorry you are suffering so much at the moment, and hope you will keep looking for help. Try to keep a positive frame of mind that you WILL get better.


  • I also agree that it's time to pack up and find another doctor. Seems like he already gave up on you. I'm surprised that you're just on Vicodin after all that you've been through. I would certainly go to another pain specialist who would at least try an extended release narcotic painkiller.

    I've never heard of a non addictive pain pump, but those which dispense morphine, dilaudid, fentanyl, or baclofen (muscle relaxer). It goes directly to the painful areas of the spine and it require a tiny fraction of the amount you would normally take orally. They hope to eliminate or cut back on whatever pain pills that you are taking once you have the pain pump implanted. This is a good alternative for people who can't tolerate the side effects from oral meds or who have not found relief from them either. It is considered a last resort measure.

    I'm hoping to have my pain pump surgery in the near future. I've tried conservative treatments and surgeries but I'm left with chronic lower back pain and permanent nerve damage. Well, I hope things work out for you and you find better relief for your pain. Take care
  • Find another Dr. I think he read too much into the rat study from 1962. We are not rats!
  • HI, Sorry to hear you are having to deal with this. It is real and if it was me I would NOT find a new doctor, providing of course you like and are comfortable with this doctor. Hyperalgesia from my understanding of it could be caused by long term used of opiods and/or a growing tolerance of opiods. I think its hard to distinguish the two. If its a tolerance issue to the current dose then that just a matter of an adjustment. But if its true hyperalgesia then that something different altogether.
    I have read about this somewhat and honestly don't know how a doctor would distinguish one from the other. I would recommend you do some research yourself that way you will be familiar with that, and try to see what category you fit into. I would be worried that this doctor saw how long you were on pain meds and labeled you hyperalgesia, but I don't know. It's a slippery slope for sure, with the amount of daily pain you are in, you don't want the help to add to the pain, so to speak. My new PM doctor mentioned this hyperalgesia to me when I first started to see her. I have been on pain meds since around 2005. I had surgery in 2007. My pain meds have changed over time, but they are still opiods. I told her that prior to my surgery in Dec. of 2007 my surgeon recommended that I go off of all pain medication for six weeks in so I would have a better pain relief outcome post op. It was difficult in the sense that I was in alot of pain pre-op but coming off the pain meds was not hard.
    At any rate, whatever you decide to , I wish you luck and pain free days.
  • I have been forwarded to yet another Pain Management Doctor who has diagnosed me with this. They, as well as my family insist I have to get off the meds. So easy for them to say that, huh?
    It is a battle that haunts me everyday. Do I think I am addictied to them, hell yeah, it only seems natural after having to take them for so long and your tolerence goes up causing you to take more. I have taken up to no more than 8 a day for the past 8 months. I have dropped from the 10/325 to the 5/325. I also have been trying to ween off of them.

    My family is trying to do an "intervention" with all my doctors, etc. They say that my personality has changed, I am a bitch and completely out of control emotionally. Well, yea, DUH! Pain is pain. I would never want anyone to endure this kind of pain on a daily basis. I take them to function and just exist. No, the surgeons have all told me there is not a darn thing that can be done. It is all due to the nerve endings in my back and I just "have to live with the pain". Can you believe that? Talk about not wanting to live anymore :(
  • My surgeon is not the one who diagnosed me. I was a Rheum/Pain Mgmt doc I saw last week. She as well as all my "other" docs are bound and determined I need to get off this med. It is so stressful for me as I have research the Hyperalgesia and it is true to what is going on in my body. It has a tendency to make things more prevelant and painful to some patients that take Opiods for a long time.
    I get massage, PT, on Cymbalta, Lamictal, Vicodin, Blood Pressure Meds and just was prescribed Celebrex to start replacing the Vicodin. The Fibro does not help one bit. A lot of the pain I am in is all caused from the nerves being "on fire" which causes the ligaments, tendons and muscles to react in a very negative way . My left leg is 1.5 inched shorter from placing my weight on one side of my body and hips. Seems the ONLY people that really know what they are taling about are the Eastern Medicine docs with the extensive knowledge of the human body. They make it clear and understandable to me what is going on with my body. Sad thing is though, that I only have a certain amount of PT visits per calendar year and it limits me to the needed PT/Massage I benefit from on a 2xweek basis. I have paid thousands of dollars out of my own pocket every year to go in and get massages. This is the ONLY form of relief I get.
    I am exhausted, in excruciating pain and left wondering why I ( heck, we all) have to suffer like this. My spine is on fire, hips and lower back feel like I have a truck laying on it and electrical shocks all the time in my mid back, legs and inner thighs. How in God's name is a person supposed to live like this on a daily basis and not think about death as an alternative.
  • The thing about opioid induced hyperalgesia is that it's supposedly identified by increasing patterns of pain in spite of increasing doses of opioid analgesics.

    I don't see how any physician can diagnose that in a patient that "maxed" at 8 hydrocodone 10/325's a day. In the face of a spine damage that results in a 6-7 level fusion, that's nothing. And, in my opinion, you can't document enough of a pattern without moving through more than one dose of more than one medication.

    In my estimation, about 95% of the time that diagnosis is thrown out by doctors it's because they don't want to face the attention that comes with writing prescriptions for more potent narcotics. Instead of admitting that they're under-treating your pain, they set out to convince you that the medication is causing your pain. Oy. 8}

    Also, it might be worth having your family read this article before they stage that full blown intervention. ;)


  • if i was you i would insist on a hospital induced withdrawal from your meds. =D> it takes 24 hours and you will not go through any of the horrible physical withdrawals that occur.. :D you will have some fatigue but beyond that you should feel nothing but drug free. =D> good luck and i hope whichever road you choose works for you. =D> Jenny :)
  • Lulu,
    The rapid detox that you are talking about has it's own concerns in the problems that those who have undergone it have reported once they got home.
    I would do some homework into it before going that route.
    I am with Bionicwoman, in that Vicky's pain is being seriously undertreated, rather than overtreated and that is at least partially responsible for her being in pain, and angry, and the other things that she described her family stating.
    With a multi level fusion, and the repeat surgery she had to undergo, vicoden is the med that she should be using for breakthrough, not as her primary pain medication.
    Vicky, I know that you feel depressed and beat upon by the doctors and your family, if not betrayed by them, but at this point, you have to advocate for yourself. If you are in pain and it sounds like you are, it is because the pain you are in is being seriously undertreated, not over treated and you really need to find a new PM, one who will try some other longer acting pain medications with you, and possibly some nerve pain meds as well, and you might be surprised at how your depression will lift some, when you are being treated properly for the pain you are in.
    Don't give into this garbage about opiod induced hyperalgesia. I truly don't believe that you are one of the people that this is happening with.
    Once your pain is properly treated, you might find that you are able to participate more in your own life, and that of your family members.
    Hang in there,
  • There have been some good points made in this thread. First off I think what you are doing by asking questions is the single most important thing you can do. Don't stop and certainly don't limit yourself to only asking questions here. Ask the docs. Write out some well composed questions and see how they respond.

    Depending on who you talk to in the medical community and their field of practice, you will find that many only embrace OIH as a theory and nothing more.

    For those medical professionals who honestly understand the theory and care about helping the person/patient, then they will know that as has been already brought up here, there are ways to verify and treat or "get around" the problem.

    The theory does buy into the fact that the dose and specific opioid isn't as important as the patient's response to the opioid. So although Vicodin isn't that strong of an opioid, it's your body's response to it, that would determine if you fit into the classic OIH definition or not.

    It can be easily validated against the common theory (which I think a doctor's duty is to validate something this serious) by something as simple as adding in concomittant drugs or changing to an opioid with different or better receptor mechanisms. There's more, but your PM doc would/should be clued into them.

    Detox, especially Rapid Opioid Detox done under general anesthesia, is not something that is worth the risk for low doses of opioids, a patient that can titrate down or off and carries with it significant risk, to include death. It IS NOT something that is a 24 hour stay in the hospital and "presto chango" you are detoxed and feel great! It is the very dangerous first step of a long and arduous process that many fail at and return to taking opioids.

    It sounds like your doc and family are right. That you probably do need intervention, but not the type you are describing that they are proposing. Intervention in the form of a good pain management program would be a smarter and seemingly more prudent way to go.

    Don't give up or give in until you can get someone to address your questions and concerns. It's your life and you're the one that lives in your body. Don't let the well intentioned misinformed cause you even further pain and discomfort.


  • I'm sorry you're having so much pain. I found that percocet changes my personality and found a slow release narcotic seems to help more. I would look for another Pain Management Dr. for a second opinion. I'm glad my own Primary Dr. controls my meds as opposed to a PM Dr. I hope you get more support from your family. I had to take my husband in to talk to the PM Dr. for him to understand better what chronic pain was. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • you ever had an EMG? I also had horrid burning nerve pain, and was told repeatedly by all doctors to "give my nerves time to heal". Except they weren't. When I finally got an EMG and it showed severe permanent S1 nerve damage, my treatment changed immediately.

    Doctors were compassionate, took me seriously. I was put on a long-acting medication which I highly recommend, as it keeps your pain under control all day long, rather than the "watch the clock" behavior that short-acting meds put us in.

    I was then recommended for a spinal cord stimulator, and for me, it has changed my life. If the SCS had not worked, my next stop was going to be the implanted pain pump. With the severe nerve damage that I have, the docs all agreed those were my only options if taking oral medications caused too many side effects or were not effective.

    Also, I found muscle relaxers to be invaluable, keeping my muscles calm. When my muscles were acting up, they spasmed on top of nerves, which caused further nerve pain. My all time favorite MR was Soma, but my clinic stopped prescribing it. I am now on Robaxin after trying Amrix (a 24 hour Flexiril) and Skelaxin, which tends to be a weaker MR but with very little sedation.

    If you do detox off of the pain meds, ask about adding a muscle relaxer to your plan. At least give it a try if you have not already.

    Also, consider getting the nerve testing - EMG and nerve conduction studies.

    I hope you find some relief. Have you tried other meds besides hydrocodone? It could be that you just need something else, and I don't understand why you've never been tried on a long-acting med but your doc is saying your OIH??

    Take care,

  • It doesn't make much sense to me. Hyperalgesia is a fairly common thing to have with chronic pain, especially if there is nerve pain. It can also be caused by a condition worsening, by being undertreated or simply building up a tolerance. I agree with Cheri that having an EMG and nerve conduction tests might be helpful, if you haven't had them already. I have neuropathic pain (confirmed following nerve conduction/EMG), including hyperalgesia and allodynia. Lots of us have it, I expect.

    Sounds more like 'ineffective pain management induced hyperalgesia' to me. Just my (non-professional) two cents worth...
  • I'm with the others that say it sounds as if you are being UNDERTREATED, not overtreated.

    As far as your family goes, they sound as if they need more education regarding pain management and opioid therapy. There is a ton of mis-information out there, and the number one piece of it is that dependence = addiction.

    Of course your moods are bad, and your personality suffers. When you are in constant pain, it effects every single part of your life.

    Get a second or even third opinion, and have a heart-to-heart with your family about the realities of opiates, including the fact that people who legitimately use their meds in a proper way for pain, and do not abuse by using when not in pain, are highly unlikely to become addicted.

    I also recommend researching Pseudo-addiction and sharing that information with your family.
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