Opioid "Induced" Hyperalgesia and Allodynia

Author: R. Norman Harden

Prolonged exposure to opioids hypothetically activates a pro-nociceptive mechanism resulting in opioid induced hyperalgesia (OIH). Opioid hysteria doctors are causing payors and governing bodies to rush to bring the OIH concept into law and protocol, but are finding a lack of any scientific evidence for this process, at least in humans. The FDA is now requiring pharma to run extensive and expensive trials to demonstrate OIH associated with opioid therapy, but the construct is vaguely defined, the mechanisms are poorly understood, and the outcomes and methods for studying OIH are very poorly developed. In this session we will examine the state of the science surrounding OIH including terminology, technology/methodology, and existing evidence. I will also present a preliminary data set executed to determine practical, workable methods to study the phenomena, and its results. Our pilot study showed no trend toward development of OIH (by our quantitative definitions) beyond the hyperalgesia and allodynia that all pain patients develop as pain becomes chronic (AKA sensitization/augmentation), which was seen equally in our control group of subjects with the same diagnosis not taking opioids. Importantly, I will try to outline practical methods for future study. (Recorded at PAINWeek 2016)

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