Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon.
Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation-a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
Launette Marie
LM
Rieb
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Wendy V
WV
Norman
Collaborating Centre for Prison Health and Education, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Ruth Elwood
RE
Martin
Sauder School of Business, University of British Columbia, Vancouver, BC, Canada.
Jonathan
J
Berkowitz
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Evan
E
Wood
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Ryan
R
McNeil
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
M-J
MJ
Milloy
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D013375:Substance Withdrawal Syndrome / Q000209:etiology* / Q000523:psychology
D000701:Analgesics, Opioid