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Hello, I am Dr. Kevin Rod

I am fortunate to be a pain patient and a pain doctor at the same time. My life experience as a pain patient qualifies me to understand pain struggle more than my education. Here are some highlights of my practice and experience: I am a Family Physician with focused practice in Chronic Pain. I am the founder and director of Toronto Poly Clinic Multi-disciplinary pain management center. I am a Lecturer with the University of Toronto DFCM as a clinical teacher. I am also a guest course contributor to Harvard Medical School department of Continuing Education.

Can Using Narcotic Medications Make The Pain Worse?

WHAT IS OPIOID INDUCED HYPERALGESIA? WHY IS IT IMPORTANT FOR PAIN PATIENTS?

 

When a patient uses morphine or any of its by-products, called, as a group, opioids, tolerance emerges over time. This is because of changes that happen at a cellular level and their opioid receptors, where the medication molecule connects to the cells. However, there might be something else happening as well. Opioid analgesics may cause more pain after a while instead of killing the pain. It means that the cells go through some changes, along with other changes in descending pain regulating pathways in spinal cord that results in less effect of opioids.

 
We always knew that patients with addictions to narcotics have a lower threshold to pain and feel more pain with painful events. However, it is interesting to find out now that long term use of opioids can lead into central nervous system and peripheral cellular changes that would lead into feeling more pain, instead of having analgesia with the use of narcotic medications. This is called opioid induced hyperalgesia or OIH.
 

The importance of this phenomenon is for the pain patients who are using narcotic medications for a long time and do not get proper pain control. It would be better for these patients to be switched to another type of medication for a while. This is called opioid rotation. It means the patient will be taken off the primary medication and put on a lower dose of a different opioid. Nonetheless, at times it maybe needed to take the

patient off the opioids all together and after a while restart with a very low dose to achieve a better pain control.

 
These changes are not easy tasks and need to be done by physicians who are familiar with this process. If one is using high doses of narcotic medications and the pain is not controlled well or if the pain has changed gradually in it’s character and has turned into neuropathic type of pain with burning, pins and needles characteristics, then the chances are that OIH is being established. Patients and doctors need to be informed about this condition and work together to correct it.

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