Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification

Abstract

These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.

Associations between Heat Pain Perception and Opioid Dose among Patients with Chronic Pain Undergoing Opioid Tapering

“…Second, the association between HP 5-0.5 and morphine equivalent dose persisted following discontinuation of opioids, which was biochemically confirmed by urine toxicology screening. Whereas persistent hyperalgesic changes to cold-induced pain following opioid tapering have been described in various patient populations [7,52,53], persistent hyperalgesia to HP stimuli has not been previously reported. Furthermore, the association between HP 5-0.5 and greater tapered morphine equivalent dosages occurred independent of persistent symptoms of opioid withdrawal.…”

Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy

“…Over half of surveyed patients (62.3%) were primary prescription opioid users, and prescription opioid misuse often stems from initial use for pain (Barth et al, 2013). A hyperalgesic state associated with opioid withdrawal is well described (Compton, Charuvastra, & Ling, 2001; Hooten, Mantilla, Sandroni, & Townsend, 2010; Younger et al, 2008); thus, the association between concern about pain and the desire to remain in BMT for longer periods of time may reflect an analgesic effect provided by sustained buprenorphine use that alleviates the hyperalgesic state and motivates continued BMT. It is interesting to note that a previous report that exclusively surveyed heroin users did not observe this association (Winstock et al, 2011), indicating that this association could be unique to primary prescription opioid users.…”

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon

“…139 Also, in preclinical models, opioid withdrawal induces central changes in neurotransmitters, along with neuroimmune and neuroinflammatory mediators involved in nociception, 43,44 thus potentially intensifying pain beyond OIH. A general increase in pain sensitivity after opioid cessation can occur after acute 4,55 or chronic 66,109,132,144 opioid exposure, referred to by a variety of names including withdrawal-induced hyperalgesia (WIH). For individuals with chronic noncancer pain (CNCP) or an opioid use disorder (OUD), severity of pain during and immediately after opioid withdrawal can be a risk factor for restarting opioids.…”