Reduced cold pain tolerance in chronic pain patients following opioid detoxification.
OBJECTIVE
One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients.


METHODS
Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay.


METHODS
We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task.


RESULTS
A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain.


CONCLUSIONS
These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.
Stanford University School of Medicine, Department of Anesthesia, Division of Pain Management, Palo Alto, California 94304-1573, USA. Jarred.Younger@stanford.edu
Jarred
J
Younger
Peter
P
Barelka
Ian
I
Carroll
Kim
K
Kaplan
Larry
L
Chu
Ravi
R
Prasad
Ray
R
Gaeta
Sean
S
Mackey
D000328:Adult; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D003080:Cold Temperature; D005260:Female; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D017288:Pain Threshold / Q000187:drug effects*; D013375:Substance Withdrawal Syndrome; D013697:Thermosensing / Q000187:drug effects*
D000700:Analgesics