Last Updated: 3/15/2019, Marc Woodard

Scientific studies prove, pain relief decreases while pain sensitivity increases from excess use of opioids. In other words, if you’re a chronic pain sufferer and have used opioids for long periods of time, greater sensitivity to pain will occur.

So you ask yourself, how could taking more pain killers cause greater sensitivity to pain? “I thought pain killers were supposed to lessen the pain.” This is true if you are following the  doctor’s pain management program. When pain pills are over prescribed, or used in abundance – the body builds up tolerance to them and you feel more pain. The medical term for this relationship is referred to as Opioid-Induced Hyperalgesia (OIH). Taking too many pain pills is the cause of more physical and mental pain addiction and increased health risk and accidental death.

Simply stated, OIH is pain intolerance, meaning to become more sensitive to any pain stimulus. How does tolerance to pain killers cause more sensitivity to pain? The best way to describe this is your body produces a morphine like substance (via spinal cord secretions) known as endorphins to alleviate pain when you stub a toe, or slam your finger in a car door for instance.

This substance lessons the painful stimuli experience. If a person takes too much for too long morphine like drugs, then the spinal cord no longer secrets the body’s natural pain relief agent.

So when your body hurts really bad (chronic) you no longer have that supplemental natural pain killing agent in your body. Instead, you solely rely on your prescriptions. The pharmaceutical prescription at this point is not enough to provide adequate pain relief. Taking too many pain killers results in an overall increase in pain sensitivity because the pain patient now blocks the body’s ability to dose/mask pain naturally for lack of the body’s natural morphine like defense.

In recent years the FDA (Food and Drug Administration) introduced REMS (Risk Evaluation and Mitigation Strategies) guidelines to help manage the known risks for pain medication use. This is a program intended to improve upon patient safety, education and compliance to mitigate risk of abuse, addiction and serious side effects through smart physician-to-patient consults.

Once these guidelines became known to the pain patience, there was fear (among some) REMS would result in limiting their access to needed prescriptions. This simply is not the goal of the FDA REMS guideline program.

Why would pain patients fear such a thing? If your addicted to pain killers and you have a risk evaluation (REMS) by a pain managing specialist, it may be determined the best course of pain alleviation may be to switch pain medications, or reduce the dose, etc. For example, a patient prescribed transdermal fentanyl medication may be reduced dosage by 25%. [Note: Fentanyl is only prescribed for the most serious chronic pain cases and is reported as one of the most lethal drugs an addict could put in their body. Death has occurred simply through skin absorption and inhalation]. Fentanyl is a potent synthetic (man-made) narcotic]. A 100g dose of fentanyl is approximately equal to 10 mg of morphine. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain.

So when a pain patient has been using Fentanyl to alleviate pain, a reduction of dose by 25% will appear odd to a patient, but necessary to get pain under control. It takes a bit of education and understanding on how to use high dose pain killers safely and effectively.

After REMS application during a 4 week period – with reduced dose – patients report overall improved coping ability with pain sensitivity.

If pain is not managed effectively, secondary health risks can and do occur. The list below targets the health risks. If you are a patient on pain medication and experience any of the symptom and signs listed below, contact your primary care physician immediately to get help.

1. Opioid-Induced Hyperalgesia – Ineffective pain relief.

2. Respiratory Depression – Slow rate of breathing, loss of urge to breathe.

3. Central Nervous System complications – Dizziness, euphoria, drowsiness, etc.

4. Cardiovascular – Decreased blood pressure, edema (swelling), slow heart rate.

5. Musculoskeletal System – Osteoporosis, muscle rigidity and contractions.

6. Skin System – Itching, this may not indicate allergic reaction.

7. Immune System – Data suggests long-term use, indicates immune suppression.

8. Pregnancy & Breastfeed-Neonatal depression, avoid opioid use during feeding.

9. Ocular System – Constriction of pupil.

10. Gastrointestinal System – Constipation, nausea, vomiting, bowel problems, etc.

11. Genitourinary System – Urinary retention.

12. Endocrine System – Hormonal and sexual dysfunction.

13. Withdrawal Syndrome – Runny nose, shivering, diarrhea, gooseflesh, etc.

14. Constipation – Increase fiber intake, and/or use stool softeners will help.

The FDA REMS guidelines are now required within all pain patient-physician consults; providing the patient an excellent opportunity to learn about the benefits and risks of using pain killers. This program will no doubt reduce prescription addiction and secondary ill-health risk factors that also decrease accidental deaths and lawsuits.

If you now have a problem with addiction and/or your pain is getting worse, or out of control – ask for help and get a referral to see a pain management specialist [Physiatrist].

Through smart pain management consults, education and timely/applicable self-referrals your pain alleviation program will work safely for you. Taking a self interest in your chronic pain and addiction circumstance is important if you want to continue living life to the fullest with loved ones.

References,

1. Pain Pathways, www.painpathways.org
2. Federal Drug Administration, www.FDA.gov
3. American Chronic Pain Association Consumer Guide, www.theacpa.org

Marc T. Woodard, MBA, BS Exercise Science, ARNG, CPT, RET. 2019 Copyright, All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.org, Sign up for your Free eNewsletter.