Colvin says she already sees strong evidence
of hyperalgesia in high - dose opioid users at the clinic where she works.
A research team in Israel reported evidence of
hyperalgesia in 17 of 30 patients with radiating spinal nerve pain by asking them to rate the intensity of heat pain on a numerical scale before and after a 4 - week course of hydromorphone.
«When I go to work every day, I don't think about opioid -
induced hyperalgesia,» says Gary Bennett, a pain researcher at the University of California in San Diego.
In addition, chronic oral administration of gabapentin (from day 24 — day 44) also reversed paclitaxel - induced mechanical
hyperalgesia when administered at 100mg / kg but not 50 mg / kg.
Although obtained in rodents, the findings suggest that EA is a potential therapy
for hyperalgesia in humans.
This rodent study investigated whether EA can
alleviate hyperalgesia during alcohol withdrawal, potentially reducing the risk of a relapse to drinking, and whether it achieves this effect via action at mu opioid receptors (MORs) located in a brain region called the lateral habenula.
The study showed that EA can lessen
hyperalgesia during alcohol withdrawal, and that the effect may involve MORs in the habenula.
His group found evidence in 91 patients tapering off opioids that those whose doses were higher at the start, forcing them to make greater reductions over the 3 - week program, had worse measures of heat
pain hyperalgesia.
Researchers already knew that even without opioids, some people with chronic pain from nerve damage or fibromyalgia, for example,
experience hyperalgesia when normal pain signaling gets reinforced and amplified over time.
So he's hoping for a different solution: a drug that targets the mechanisms
behind hyperalgesia and that might be given alongside an opioid, either when it's first prescribed or when a doctor suspects OIH.
For some, this lack of evidence makes research
into hyperalgesia look like a dead end.
«Just imagine if all the diabetic medications, instead of decreasing blood sugar, increased blood sugar,» says Jianren Mao, a physician and pain researcher at Massachusetts General Hospital in Boston who has
studied hyperalgesia in rodents and people for more than 20 years.
But how
prevalent hyperalgesia is, and whether it plays a role in the U.S. epidemic of opioid abuse and overdose, is unclear.
If so, doctors who
ignore hyperalgesia might bump up the dose when the right decision was to reduce it.
Many see dampening this inflammatory response as a promising way to
fight hyperalgesia, because it would not interfere with opioids» pain - relieving activity on neural receptors.
A few researchers, like Mao,
think hyperalgesia is an underappreciated puzzle piece in the opioid epidemic — a force that can pile on pain, drive up doses, and make it harder for chronic users to come off their drugs.
Subsequent studies showed that inhibiting the inflammatory molecules released by glia could
reverse hyperalgesia and tolerance in the rats.
They told the participants that the cream could cause increased sensitivity to pain — a known side effect of real medications
called hyperalgesia.
In fact, research indicates that the pain of
hyperalgesia occurs because the morphine latches on not only to cellular targets that reduce pain sensation but to other «non-opioid» targets that result in activation of pain - sensing neurons.
In rodents, administration of paclitaxel causes neuropathic pain that comprises of
thermal hyperalgesia and mechanical allodynia, which can be reversed by different analgesic agents.
A combination of peppermint oil and caraway oil attenuates the post-inflammatory
visceral hyperalgesia in a rat model.
Neuropathic pain develops when damaged or dysfunctional nerves send inappropriate signals to the brain.7 Neuropathic pain can result from diabetic neuropathy,
hyperalgesia syndrome, previous trauma, and onychectomy.
It has been shown to be effective at
reducing hyperalgesia and allodynia associated with neuropathic pain.
The experiment was Hutchinson's first encounter with a perplexing phenomenon called opioid -
induced hyperalgesia (OIH).
If you can't reliably
diagnose hyperalgesia, it's hard to predict its long - term effects, says Michael Hooten, an anesthesiologist at the Mayo Medical School in Rochester, Minnesota.
The evidence
for hyperalgesia is clearest in people taking extreme doses — for instance, in opioid abusers or terminal cancer patients managing severe pain.
Researchers trained male rats to drink alcohol for eight weeks, after which they discontinued the alcohol supply, which led to withdrawal symptoms,
including hyperalgesia.
Markers of inflammation in the blood might correlate with clinical signs
of hyperalgesia or declining pain thresholds on sensory tests.
We treat many people with complex chronic pain problems and the MYO Buddy Pro Massager plays an essential role in reducing allodynia and
hyperalgesia in our toughest cases.
Hutchinson thinks the majority of physicians are either unaware of
hyperalgesia or unconvinced of its importance.
He believes the risk of
hyperalgesia should motivate doctors to try tapering patients off their opioids when their pain worsens without an obvious cause.
After the drug treatment, the team found signs of
hyperalgesia: On average, the subjects registered pain from the ice water about 2 seconds earlier, and removed their hands about 8 seconds earlier, than they had beforehand.
Some of those researchers are looking for ways to turn down
hyperalgesia, to help patients function on lower doses of their oxycodone, for example, or make it easier to taper off it altogether.
Surgical patients given large amounts of the opioid remifentanil have shown signs of
hyperalgesia; they have larger areas of soreness around their wounds and seem predisposed to chronic pain following surgery.
In addition, such drugs can, paradoxically, actually cause pain, a condition called opioid - induced
hyperalgesia.
To assess whether EA alleviated
the hyperalgesia, they measured pain sensitivity using radiant heat (a light beam directed at the hind paw of each rat) and measured paw withdrawal latencies to the light stimulation, with and without EA.
Some people also get opioid - induced
hyperalgesia — opioids ramp up their pain instead of knocking it down.
The use of opioids is commonly associated with opioid tolerance (OT) and opioid - induced
hyperalgesia (OIH), which limit efficacy and compromise safety.
Another condition associated with opioid use is opioid - induced
hyperalgesia (OIH), where the patient grows even more sensitive to pain.
Related consequences include altered menstrual flow, probable reduced fertility, and possible contributions to opioid - associated depression, osteoporosis, and
hyperalgesia.
We treat many people with complex chronic pain problems and the Myobuddy plays an essential role in reducing allodynia and
hyperalgesia in our toughest cases.»
[176] I accept the opinions of Dr. Purtzki that the plaintiff has evidence of allodynia and
hyperalgesia and seems to experience non-painful stimuli as painful and mildly painful stimuli as more painful, as a generalization to the area of pain.