The Future Is HYPERALGESIA - Pain Management Message Board

Query · 03-12-2007, 04:09 PM

I am a chronic pain patient and I am in the process of moving to a big city. I have documented severe pain, and the MRIs and medical history to back it all up. A few months ago, I went to a well-known university teaching hospital to the pain management clinic in the city where I am moving (no names here, because I am starting to get paranoid about all of this!) I was hoping to get a new doctor in my new city. They told me to go off all my narcotic medication. They said they are telling that to everyone who comes in on 'high doses' of narcotics. I said what is a high dose and they said anything over a few hundred mgs. They said that there are studies on 'hyperalgesia' that prove that narcotics cause pain. When I got home, I went on the Medline and Pubmed (big online libraries where the medical journal articles are all published) and at that time found I only two medical articles about 'opioid induced hyperalgesia' that seemed to be relevant. Now there are a lot more.

This is the future for us! Is anyone afraid? I am! Does anyone want to talk about it?

Shoreline · 03-14-2007, 05:30 AM

Hi Querry, It's really not uncommon to end up on a decreased dose when you switch PM docs, It may just be that the new doc isn't comfortableprescribing the doses of meds your old doc was . It ay have taken years of earned trust to reach that level of medication with your old doc and the new doc simply isn't comfortable prescribing this level of medication.

This is the 3rd or 4th post on the subject of such a rare phenom that your doc or what you found is suggesting isn't quite so rare, although it may simply be the new opiate phobs party line on restricting doses of opiates. Personaly I don't buy the theory but there may be nore too it. Basicaly if you take the unexplainabale phenom of tolerance and stretch it out over years, eventually everyone will be on higher doses of meds to maintain the same level of relief, is this hyperalgesia, or just tolerance and doses being used far higher than ever imagined being used by the established med community? Your certainly not the first to have their dose reduced by a new doc, calling it hyperalgesia is new, but how many other times have we been lied to about opiates.

My last surgeon told me it was against the law to prescribe more than 50 class 11 meds on a single script. I knew that wasn't true, but what was I too do, call him a liar 2 weeks post op from a 6 level fusion revision? We are still a the mercy of docs and teling him he was full of beans wouldn't have gotten you very far with the new doc so he caused you to research a subjusct that there is some info about on medline. Heck there is probably info about the rediclous claim by PETA that beer is beter for your children than milk and certain medical eveidence to back the claim , does it really mean you want to switch your 2 year old from milk to Budweiser?

Or do you get the impression you can find info on the net to suport just about any medical claim you can imagine. It doesn't make it true, it just means the question has been asked before and slighly studied in biased interpretation of clinical findings. You can find info to support any claim you can imagine from the most extreme ideas to the most basic understanding of opiate use in CP patients.

What do you think, did you feel better overall when you med was reduced and you bod had gobe through the adjustement perriod "withdrawal" to become acomaadated tothe lower dose, or do you feel it was jusy more BS based on his individual comfot level?

Prior to 96, it didn't matter what kind of injury or surgery you had, when you came home from the hospital, you got 5 mg percs.There were no 10 mg perc available or 30 mg roxicodone even on the market. We made due with having the edge taken off and that's all there was too it. Now those post op doses for major surgeries like hip replacements, TKR's, long fusions and other major surgeries make 5mg percs lok like tic tacs in comparision.. Those doses are considered weak compared to what's available now. The only thing stronger they could give you prior to these stronger meds all hiting the market in the last decade was dilaudid and it had such a bad rep as far as IV abuse and was called pharamcuetical Heroin and sold for 10 bucks a mg as far back as the early 70's there simply was no other choice. You suffered, but made due and didn't die from porly managed post op pain.

Now there are doses of oxycodone that make 2mg dilaudid that sold for 20 bucks a pill look like baby aspirin. A 60 year old doc who never would have prescribed dilaudid is now faced with patients taking hundreds of mgs of oxy and thousands of mics of fentanyl more often than a doc would have prescribed Dulaidid n the 80's. He has to pull some reason out of the air to reduce your dose and why not something as obscure as opiate induced hyper algesia you can't posibly argue it or put you in the position of looking for a new doc and being called an addict because your dose exceeds his comfort level.
We are at the mercy of the docs and honestly if there wasn't a doc in control of our medication, It' a scarry situauatuon as far as doses and patients not willing to except the limits of opiate medication. So docs prevent patients from going nuts and simply jacking their tolerance through the roof leaving them nowhere to go in as as little as a couple years when dealing with a life long problem.

JMO, Take care, Dave

forginon · 03-14-2007, 01:08 PM

I am concerned this could gain a life of its own. What it will be called - who knows?

I was coerced into a detox two years ago under what one could call a diagnosis of hyperalgesia. At the time the term being used was rebound pain. I was on a very high dose of duragesic patches and actiq lozenges. There were a whole host of things wrong with me at the time, and I was exhausted and open to suggestion. I was in the hospital and my GP wanted me to see a shrink. He visited and essentially told me that the reason my pain mgt regimen appeared to be failing was because I was suffering from rebound pain. In other words, the meds were now causing pain. Off I went into buprenex he!!.

I have read lately about hyperalgesia. The writings that sound most informed lean towards a chemical change in how our bodies react to opiates, and that an "excitatory pathway" (the reason these meds can cause a euphoric or stimulant effect) suffers a change that ultimately results in contributing to the very pain we're trying to reduce. I'm sure there's others that can explain this much better than I have.

Bottom Line? My concern isn't that there'll be a reduction in the use of opiates but rather doctors will no longer be willing to prescribe the ("high") doses necessary to manage some patients pain. Some doctors may impose a limit in an effort to prevent hyperalgesia. My concern is that the limit may be so low that for many pain cannot be managed.

I think this is something we should watch closely and for those with outstanding pain mgt doctors to strike up a dialog with them and get their take on this, and of course let the rest of us know what's being said by them.

steve