After attending a recent lecture by Brian Johnson, MD I realize that I have been failing to consider a potentially important factor in many of my patients with pain system dysfunctions— Opioid induced hyperalgesia (OIH).
There is a growing number of studies which suggest even short term use of opioids can lead to a reduction in pain threshold. For example, studies by White and Hay found significant reductions in cold pressor test tolerance in people on opioids. Other studies demonstrated significant improvement in cold pressor times after detox from opioids.
So what should physical therapist do when the pain medication, which is supposed to be reducing pain in our patients, is actually leading to more pain? I know that I will be quick to send my patients who are on opioids and have signs of hyperalgesia to Dr. Johnson for detox. I will also include education on OIH to patients who take opioids or are considering taking them.
Here is a recording of the lecture by Dr. Johnson. I think it is worth watching.