The document discusses opioid induced hyperalgesia (OIH), where increasing opioid doses worsens pain over time despite no changes in the underlying condition. An elderly woman's pain kept increasing despite higher opioid doses from her physician. The key clues are that her pain worsened with increased opioids and there was no objective evidence of worsening issues. This suggests OIH as the likely cause. The recommendation is to taper opioids under medical supervision and consider alternative therapies to improve her quality of life.

1. What is Opioid Induced Hyperalgesia
(OIH)?
Ramesh Kumar, MD
LifeWellMD.com
Palm Beach Gardens, Florida
561-210-9999

2. My Experience
Elderly female comes in who had an injury several years ago and her
physicians placed on Morphine and Percocet initially but decided to continue
it. Her pain continued to get worse, she was referred to a “Pain” specialist,
who has been increasing her dose of Morphine but her pain has continued to
increase despite this…..
Her daughter is extremely concerned about her mother’s situation and
brings her to me for an evaluation of her situation.
She wants to know if we need to continue to increase her opiates despite the
fact that there have been no significant objective changes to explain the
need for more and more pain medications..

3. So, what is the next step??

4. The Clue
The key information is that the “pain has continued to get worse
despite increasing her Morphine and Percocet”
AND
“No change in objective evidence to explain increasing pain”
Therein lies the clue!

5. The Analysis: First Possibility
Possible that there may be other underlying causes of pain that have
been missed.
If this was true escalating the dose of her pain meds should have
helped ease her pain.
So, unlikely that this first possibility is true

6. The Second Possibility
Addictive Behavior. She is afraid that the physicians will lower or
maintain the same level of her pain meds and continues to feel ”the
pain” and the only way to maintain her status is to continue to justify
needing more pain meds. She truly believes that she is in pain.

7. The Third Possibility
The phenomenon that most physicians are unaware of:
Opiate Induced Hyperalgesia, abbreviated as OIH.
Pain INDUCED and WORSENED by increasing Opiate dosing
The Unrecognized Culprit…Gotcha!!

8. Recognizing OIH
1. Increasing Opiate dose makes the pain worse.
2. Areas of pain is more diffuse and ill-defined.
3. Pain intensity is very vague and fluctuates wildly, most times the
areas of pain is “hyperalgesic” (Extremely Sensitive).
4. Reducing and tapering down the Opiate medications helps make
the pain better.

9. Final Thoughts
Long Discussion with the patient and her daughter..explained to them the
need to go back to their ”Pain Specialist” and discuss this phenomena of
OIH. Recommendation was to taper down the Opiate medications under
medical supervision and manage withdrawal symptoms.
&
Consider Meditation, Medical Acupuncture, Whole Body Photo-Bio-
modulation therapy, Suboxone, NAD+ IV infusion therapy as adjuvant
alternative therapies with the intention of improving her quality of life.
How many of these folks with non-malignant, non-terminal chronic pain
syndromes are out there who continue to be mismanaged in 2019?