In response to America’s opioid epidemic, physicians, pharmacists, and even insurance companies have been increasingly raising the bar on who can receive opioid medications in addition to how much and for how long. It’s not just the addiction risk that calls for caution when using opioids to treat chronic neck or back pain though — long-term use of opioids may also worsen pain.
How opioids may increase pain over time
Taking opioid medications over a long period of time may increase your sensitivity to pain, known as opioid-induced hyperalgesia. While the exact mechanism for how this increased pain sensitivity develops is still being studied, it likely involves multiple factors. 1 Hayhurst CJ, Durieux ME. Differential opioid tolerance and opioid-induced hyperalgesia: a clinical reality. Anesthesiology. 2016;124(2):483-8. doi: 10.1097/ALN.0000000000000963. , 2 Yi P, Przbylkowski P. Opioid-induced hyperalgesia. Pain Med. 2015 Oct; 16 Suppl 1:S32-6. doi: 10.1111/pme.12914.
Additionally, the amount of time it takes for opioid-induced hyperalgesia to develop can vary. It is commonly thought that taking relatively large doses of opioids for a long period of time (many months) increases the risk for developing this condition. Although, some evidence suggests that some people may develop opioid-induced hyperalgesia more quickly than others, such as within a month. 2 Yi P, Przbylkowski P. Opioid-induced hyperalgesia. Pain Med. 2015 Oct; 16 Suppl 1:S32-6. doi: 10.1111/pme.12914.
Differences between opioid tolerance and hyperalgesia
Opioid-induced hyperalgesia can feel similar to opioid tolerance. With opioid tolerance, the body has developed a tolerance for the opioid and needs more and more of it to get the same amount of pain relief. In cases when an opioid tolerance is developing, the patient may feel an increase in pain when the medication dosage has remained steady.
When you’re taking an opioid medication, it is important to communicate with your doctor if you notice an increase in pain or any other unusual side effects. The sooner your doctor is alerted, the sooner he or she can accurately evaluate your situation. Sometimes a change in medication or dosage may be needed.
Alternative treatment options
Since long-term use of opioid painkillers is a risky option for controlling chronic pain, patients may be advised to focus on other methods for managing chronic pain, such as:
- Other pain medications that are considered lower risk (some examples your doctor might consider include NSAIDs, CBD, or medical marijuana if it’s available in your state)
- Transcutaneous electrical nerve stimulation (TENS)
- Exercise to maintain motion and release endorphins
- Cognitive behavioral therapy to develop coping techniques
- Manual (massage) or topical (heat or cold) therapies
- Relaxation and meditation techniques to distract the brain from pain
In cases when your doctor has determined that the pain-relief benefits of short-term opioid use are likely to outweigh the risks, opioids may be prescribed. At times, your insurance company may need to be in contact with your doctor to approve use beyond seven days. To reduce the risk for serious complications, remember to carefully read medication labels and follow the directions from your doctor or pharmacist.