Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study

Abstract

BackgroundIncreased pain sensitivity is a putative risk factor for chronic pain and consequently for analgesic use. Conversely, analgesic use may be a cause of increased pain sensitivity, e.g., through opioid-induced hyperalgesia. We aimed to study the association between pain sensitivity and analgesic use in a general population, and to test the hypothesis that increased baseline pain sensitivity is a risk factor for future persistent analgesic use.MethodsThe Tromsø Study (2007–08), a population-based health study, was linked with eight years of prescription data from the Norwegian Prescription Database. The cold pressor test was completed in 10,486 participants aged 30+ years, and we used cold pressor endurance time as a proxy measure of pain sensitivity. Cross-sectional associations with different measures of analgesic use were assessed. Furthermore, a cohort of 9,657 persons was followed for 4.5 years.ResultsIn the cross-sectional analysis, increased pain sensitivity was associated with analgesic use; regular users of opioids alone were more pain sensitive than regular users of non-opioid analgesics. Increased baseline pain sensitivity was a risk factor for persistent analgesic use, i.e., using non-steroidal anti-inflammatory drugs, paracetamol, or opioids for ≥ 90 days and proportion-of-days-covered ≥ 40% (HR = 1.22, 95% CI 1.06-1.40), although not statistical significant after confounder adjustment.ConclusionsIncreased pain sensitivity was associated with analgesic use in general, and reduced pain tolerance was found for both opioid and non-opioid analgesic users. The data suggest that hyperalgesia is an effect of analgesics, whereas pain tolerance has little impact on future analgesic use.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-017-0149-2) contains supplementary material, which is available to authorized users.

Neuropsychological functions of verbal recall and psychomotor speed significantly affect pain tolerance

“…Our finding that daily use of analgesics significantly decreasing cold pressor tolerance in the oldest age group are in line with previous findings from some of the current authors regarding analgesics and the cold pressor test (Samuelsen et al, ). These findings are somewhat contra‐intuitive, but indicate that the frequent use of analgesics is associated with a reduced pain tolerance in those over 70 years of age.…”

“…Daily use of analgesics by older persons could then be a proxy for them being more pain sensitive in general. The endogenous opioid pathways recruited by analgesics are likely the same pathways involved in cold pressor tolerance, and the disruption of these would give higher pain sensitivity and reduced effect from analgesics (Samuelsen et al, ).…”

Quantitative sensory testing is feasible and is well-tolerated in patients with sickle cell disease following a vaso-occlusive episode

“…The concomitant or recent use of pain-relieving medications such as acetaminophen, NSAIDs, and opioids may alter pain sensitivity and may limit interpretation of findings on QST. 45 The presence of opioid-induced hyperalgesia due to the recent administration of opioids may also limit interpretation of QST. This may be particularly relevant in patients on chronic opioids.…”

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

“…In a large population-based study, opioid use was associated with increased pain sensitivity compared to patients taking non-opioid analgesics. This may reflect OIH (figure 1), or a pre-existing reduction in endogenous pain inhibition, increasing the likelihood of long term opioid use (45). Non-opioid perioperative analgesia may be most beneficial in these patients.…”