Opioid-Induced Hyperalgesia: What Happens When Opioids Fail

Can Opioids Make Your Pain Worse?

Opioids are prescribed to relieve pain, but in some cases, they worsen pain instead. We call this condition opioid-induced hyperalgesia (OIH). It makes the body more sensitive to pain. As a result, people feel more discomfort, even when they keep using opioids.

Many people mistake OIH for opioid tolerance, assuming they need a higher opioid dose for relief. However, increasing the dose of opioids can actually make pain worse, creating a dangerous cycle.

Recognizing the symptoms of opioid-induced hyperalgesia is important. Seeking the right treatment helps manage chronic pain. This approach can prevent increased dependence on opioids.

What Is Opioid-Induced Hyperalgesia?

Opioid-induced hyperalgesia (OIH) occurs when long-term opioid therapy changes how the central nervous system processes pain. Instead of reducing discomfort, opioids amplify pain signals, making even mild sensations feel unbearable.

This condition is not the same as opioid tolerance. With opioid tolerance, the body responds less to opioids over time. This means that people need higher doses to achieve the same pain relief. With OIH, opioids actually lower pain tolerance, causing increased pain despite continued medication use.

Opioid-Induced Hyperalgesia vs. Opioid Tolerance

Many people confuse OIH with opioid tolerance, but they are not the same. Understanding the difference is key to choosing the right treatment approach.

• Opioid tolerance means the body adapts to opioids, requiring higher doses to achieve the same effect.
• Opioid-induced hyperalgesia happens when opioids sensitize pain receptors, making pain worse rather than relieving it.

Since these conditions have opposite effects, using a higher opioid dose for OIH can make pain worse instead of better. A proper diagnosis is essential to determine whether reducing or stopping opioids is the right solution.

Opioid-Induced Hyperalgesia Symptoms

The side effects of OIH often mimic opioid withdrawal or worsening chronic pain, making it difficult to recognize. Many people assume they need a higher opioid dose, leading to further pain sensitivity.

• Increased pain despite continued opioid use
• Pain spreading to new areas of the body
• Pain feels sharper, more intense, or burning
• Shortened pain relief from opioid analgesics
• Heightened sensitivity to normally mild pain (painful stimuli)

If you experience these effects of opioids, it may be time to explore alternative opioid-induced hyperalgesia treatment options.

Cause of Opioid-Induced Hyperalgesia

The cause of opioid-induced hyperalgesia lies in how opioid receptors react to prolonged exposure. Over time, opioids trigger changes in the central nervous system, leading to increased pain sensitivity instead of relief.

• Overactive pain receptors – Long-term opioid use stimulates opioid receptors, making pain signals stronger.
• NMDA receptor activation – Opioids play a role in increasing NMDA receptor activity, which heightens pain perception.
• Increased inflammation – Chronic opioid use disrupts normal brain function, leading to inflammation and amplified pain responses.

Because opioids play a role in causing OIH, increasing the dose of opioids is not the answer. Instead, finding alternative pain management strategies is key.

Guidelines for Treating Opioid-Induced Hyperalgesia

The first step in treating OIH is recognizing that higher doses of opioids won’t help. Instead, we need a structured approach to reduce opioid dependence while managing pain effectively.

• Gradual opioid tapering – Slowly reducing opioid use prevents withdrawal and helps the body adjust.
• Non-opioid pain relief – Alternative medications, such as NMDA receptor antagonists, can help reset the brain’s pain response.
• Ketamine therapy – This treatment is effective in blocking opioid receptors and reducing pain sensitivity.
• Behavioral therapy – Psychological support helps patients manage pain without relying on opioids.

Using the right guidelines for treating opioid-induced hyperalgesia can help prevent suffering. This can also lead to long-term pain relief.

Overcoming Opioid-Induced Hyperalgesia at Hart Rehab

If opioids are making your pain worse, you need the right treatment—not more medication. Hart Rehab specializes in opioid-induced hyperalgesia treatment, helping patients safely reduce opioid use while finding real pain relief.

Our expert team provides safe, medically supervised detox to ease withdrawal and lower dependency. We provide different ways to manage pain. This includes non-opioid medicines and holistic therapies.

Our goal is to help your body respond better to pain. We personalize every treatment plan to target the root cause of opioid-induced hyperalgesia, not just mask symptoms. You don’t have to suffer or rely on increasing opioid doses to function. With the right care, you can regain control of your pain and your life.

Contact Hart Rehab today to start your journey toward lasting relief.