Opoids and Pain

 

Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli. The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain.

In a recent study, “A comprehensive review of opioid-induced hyperalgesia.”

OIH appears to be a distinct, definable, and characteristic phenomenon that could explain loss of opioid efficacy in some patients. Clinicians should suspect OIH when opioid treatment’s effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the original pain, and increased levels of pain with increasing dosages. The treatment involves reducing the opioid dosage, tapering them off, or supplementation with NMDA receptor modulators.

https://www.ncbi.nlm.nih.gov/pubmed/21412369/

In a study in Oregan, people who had spinal surgery that were on Opoids for pain before going into surgery still needed them after surgery and in fact did not stop taking them. Deyo and colleagues studied nearly 2,500 adults who underwent lumbar spine (lower back) fusion surgery in Oregon, using the state’s prescription drug monitoring program to quantify opioid use before and after the surgery. They defined long-term postoperative use as more than four prescriptions filled in the seven months following the surgery, with at least three prescriptions filled more than 30 days after the surgery. They found that 1,045 patients received long-term opioids before surgery and 1,094 received them after surgery. Among the long-term users, 77 percent continued long-term use and 14 percent had episodic use. About 9 percent discontinued using opioids or only used them shortly after surgery.

As part of the analysis, Deyo and colleagues found that the prescription dose before surgery was the strongest predictor of long-term use after surgery.

“It’s not fair to say that continued use represents failure of the surgery, but instead, it represents poor transitions of care and a failure to coordinate care for patients,” said Dr. Chad Brummett of the University of Michigan Medical School, who was not involved in the study.

Brummett and colleagues launched the Michigan Opioid Prescribing Engagement Network in 2016 to develop a preventive approach to the opioid epidemic in the state. They plan to tailor opioid prescriptions in the post-surgery and acute care settings.

“For those using opioids and seeking surgery to cure the pain, it’s critical to work with your doctor to wean you down, both before and after surgery,” SOURCE: bit.ly/2pKd3bK PAIN, online March 6, 2018.

When you develop a resistance to these drugs you tend to take more and the effects continue to become less. Then if you happen to take yourself off them or reduce them  your resistance goes down.  A factor that contributes to overdose is going back on them at the increased dose you once were at before coming down on them.  It is important to work with your doctor in any situation and not take dosage into your own hands.

One final word about opoids,  more than 30 percent of overdoses involving opioids also involve benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia. … Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others. Its important not to mix doses

Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepinesUnfortunately, many people are prescribed both drugs simultaneously. A recent study showed that people concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

Previous studies have also highlighted the dangers of co-prescribing opioids and benzodiazepines. A cohort study in North Carolina found that the overdose death rate among patients receiving both types of medications was 10 times higher than among those only receiving opioids.In a study of overdose deaths in people prescribed opioids for noncancer pain in Canada, 60 percent also tested positive for benzodiazepines.  Ptients should consult with their doctors about the potential dangers of using various medications and substances together, including the use of alcohol.

https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids