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14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management: An Experts' Roundtable
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

Demystifying Opioid-Induced Hyperalgesia

Some insurance companies have declined to continue paying for opioid medications, citing OIH. Here's why.
Pages 20-21
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  • When an opioid is initially prescribed, the dose is deliberately low in order to assess side effects and then increased to an effective analgesic dose
  • A short time after reaching an initially effective dose, the most common reason for decreased pain relief is increased activity, a desirable outcome often requiring a dose increase
  • Decreased efficacy months after a stable effective dose is often due to disease progression. 

In other words, there are several well-established reasons other than possible OIH to explain why prescribers often find it necessary to increase the opioid dose in a patient with chronic pain. If a patient is functioning with adequate pain relief on his/her current dose of opioid, decreasing the dose, as the insurance company may suggest, is not in the patient’s best interest. The outcome of such a decision is likely to be increased pain and decreased function.

If a patient continues to experience significant pain, the solution is not to simply reduce the opioid dose, but rather to review the entire treatment plan and (if not already a part of the treatment) add other modalities such as behavioral health assessment and treatment, physical therapy and ongoing home exercises, non-opioid medications, complementary medicine, interventional procedures, etc. A reduction in dose may then be possible when the patient is engaged in these modalities. It is also possible that the patient would benefit from an increase in dose, or trial of a different opioid, such as buprenorphine.

Last updated on: February 4, 2019
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Misuse of ‘Hyperalgesia’ to Limit Care
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