“Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate.” – Wilson S et al 2021
There are numerous studies on OIH and the physiological explanation of OIH goes well beyond my level of understanding of neuropharmacology. I have therefore in my head produced a simpler explanation as to how dependence on any pain-reliever may actually worsen and maintain physical pain.
Imagine if you were a brain that had become dependent on opioids for emotional or physical pain-relief. Now imagine that you, as the brain, suddenly craved your next opioids fix, but you knew full well that it was not “good for you”. You may use willpower to successfully resist the craving for a while, but then, as the brain, you come up with a brilliant idea. In order to justify taking another dose of opioids, you INCREASE the pain experience to motivate and force your body to seek pain-relief.
Therefore technically, escaping pain is the ultimate cause of any addiction. The greater the pain, the more reason and justification to take the feel-good remedy whether opioids, alcohol or manual therapy. The brain being pretty smart will intentionally increase pain in order to satisfy its craving for pain-relief.
I fully appreciate that I am simplifying an extremely complex topic such as addiction, but I simply wish to shed light that chronic pain and addiction are interrelated!
“Alcohol is an effective and widely utilized analgesic… chronic use of alcohol can actually facilitate nociceptive sensitivity over time…” – Cucinello-Ragland et al 2020
“Alcohol dependence and chronic pain share common neural circuits…” –Apkarian et al 2013
“…pain treatment could potentially represent a significant risk factor for addiction in vulnerable populations.” – LeBlanc et al 2015
I recently saw a patient who had a 3-year history of low back pain. She had seen and was continuing to see several healthcare providers including physio, chiro, massage, and osteopaths, all offering temporary relief. Upon my review of her history, her MRI and a thorough physical assessment, I was unable to find any physical impairment and therefore concluded that she was centrally sensitized.
I proposed the theory that she may be “addicted” to her pain which was offering her a reason to seek temporary relief. She was baffled by my suggestion to discontinue all visits to her different healthcare providers, even though they provided her with some relief. I suggested that perhaps she needed to stop seeking pain-relief in order to eventually feel better. (I also gave her the pain truth booklet)
Within 3 weeks, she was utterly shocked that her symptoms had improved by 80% without receiving any treatments. She admitted to having a profound life alerting revelation following our first session together and after reading the booklet. For the first time, she appreciated that her addiction to temporary relief was a possible contributing factor to maintaining her pain.
Pain can be addictive as it may give us the excuse needed to seek temporary relief, whether through, self-stretches, manual therapies or various drugs.
The anticipation of pain-relief can release dopamine, and dopamine is addictive!