3 Essential Questions to Answer Before Taking An OTC Pain-Relief Medication

How much do you want to bet that there is at least one type of over-the-counter (OTC) pain-relief medication in your house? With such a huge number of available OTC medications on the market, we would bet the odds are in our favor. Drugs such as ibuprofen, aspirin, acetaminophen, and naproxen are some familiar medication names and all fall into the spectrum of OTC pain relievers. But have you done your due diligence and made sure you’re not putting yourself at risk before deciding to take these drugs, or do you know which OTC medication is best for your current condition? Unfortunately, the answer for many people is, “no”; but it’s not their fault! Yes, these are medications that do not require a doctor’s prescription, but they can pose a risk for some, where proper education is needed.

Warnings as well as research done by the U.S. Food and Drug Administration (FDA) have often called over-the-counter pain-relief medications’ safety into question. For example, the FDA disseminated a warning that non-steroidal anti-inflammatory drugs (NSAID’s) may raise the risk of heart attack and stroke. Unless you’re an avid FDA news savant, studied pharmacology, or spent years in medical school; the general public is just not equipped with the knowledge to determine if they can safely take these medications. But you’re in luck! We would like to go over three essential questions you should be able to answer before you head to the nearest Walgreens for some Tylenol®; however, please talk to your doctor before taking an OTC pain-reliever. He or she knows you best and will help guide you in the appropriate direction in reaching pain-relief.

Why have you turned to a pain-relief medication?

The cliché, “more bang for your buck” is appropriate here. Anyone taking a medication wants to take the lowest dose possible with the minimum risk of side effects while having the most therapeutic effect possible. Let’s say you are dealing with osteoarthritis. Research has found that acetaminophen has been shown to be favorably effective at relieving osteoarthritis symptoms. Studies have also found that acetaminophen is effective at treating headaches while avoiding side effects regarding cardiovascular or digestive diseases. We must note that this is assuming acetaminophen is the only medication you are taking (we’ll go into further detail later). On the other hand, NSAID’s may pack a punch against dysmenorrhea (painful menstrual cramps) and muscle aches for some patients.

Do you currently suffer from other conditions?

Before considering what medication to take, have in mind if you also have conditions other than the chief complaint. For example, NSAID’s like Aleve® & Advil® can be hard on the digestive system where long-term use of these medications cannot only upset your stomach but may pose a risk for severe stomach ulcers. If you suffer from digestive diseases, consult a doctor before taking Advil® or Aleve®. The same goes for those who have kidney disease, because NSAID’s can decrease blood flow to the kidneys.

Recently, the FDA released a warning about NSAID’s identifying those who have had a recent bypass surgery or heart attack, specifically. If you fit into these categories, it is all the more reason to consult your doctor before taking a pain medication. For instance, acetaminophen might be a better choice for you. To drive home how OTC pain-relief drugs can exacerbate multiple conditions, if you suffer from liver disease, avoiding acetaminophen (e.g. Tylenol®) is in your best interest because of the potential negative symptoms acetaminophen can have on the liver. These are just a few examples among many. If you’re in good health, such concerns may not apply to you. But any chronic condition will play a part in drug safety.

Are there other medications you are currently taking?

Polypharmacy, or rather taking more than one medication concurrently, contributes significantly as to if you should be taking an OTC pain-relief medication or not. Most drugs undergo metabolism by the same enzymes in the liver. These interactions between drugs, also known as drug-drug interactions (DDI’s), can influence the overall effect of a given medication. Some drugs may synergize the response of other drugs while some drugs can inhibit the reaction of others. For example, if you are taking a blood thinner such as warfarin, adding NSAID’s for pain-relief significantly increases your risk of hemorrhaging (bleeding), while acetaminophen in higher doses may have a mild interaction with warfarin, it may be a better choice if your doctor advises it.

What we would like you to take away from this article is that if you are suffering from a chronic condition such as rheumatoid arthritis or degenerative disc disease, it is entirely ok to ask for your doctors’ and pharmacists’ advice. The package inserts that come with prescription medications can be a lot to process and so can the labels on over-the-counter drugs. A little expert advice on drug interactions can help you get the pain-relief you need while avoiding unwanted side effects. Once you and your healthcare team have decided on an over-the-counter medication that works best for you, remember to take it with caution considering the minor side effects that are mentioned on the package. Even then, take it only when needed and take the least amount that controls your symptoms. Which over-the-counter drugs have worked for you? Let us know!

Tags: painkiller, pain reliever, NSAID’s, adverse side effects, pain management


  1. FDA Consumer Health Information. COX-2 Selective (includes Bextra, Celebrex, and Vioxx) and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). fda.gov/consumer. April 2005.
  2. FDA Consumer Health Information. FDA Strengthens Warning of Heart Attack and Stroke Risk for Non-Steroidal Anti-Inflammatory Drugs. www.fda.gov/consumer. July 2015.
  3. Lenzer J. FDA advisers warn: COX 2 inhibitors increase risk of heart attack and stroke. BMJ 2005;330:440.
  4. Moling O, Cairon E, Rimenti G, Rizza F, Pristera R, Mian P. Severe hepatotoxicity after therapeutic doses of acetaminophen. Clin Ther 2006;28:755–760.
  5. Rampal P, Moore N, Van Ganse E, Le Parc JM, Wall R, Schneid H, Verriere F. Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses. J Int Med Res 2002;30:301–308.

New Year’s Kisses & Pain Medication Don’t Go Well With Alcohol

You did it! You survived Christmas! We hope you had an excellent time getting together with friends and family as well as having a lovely time at all your Christmas parties. We also hope our blog post, “’Tis the Season! How Alcohol Can Interact with Your Pain Medications” brought you some solace in understanding how alcohol may not be your best drink of choice if taking a pain medication. Given that New Year’s Eve is today where tonight is a night that is all too familiar for partying with alcohol, we would like to go a little deeper into how alcohol is processed in the body as well as provide three major classes of pain medications and their specific interaction with alcohol. Overall, we hope that this furthers your understanding of the medications you may be taking and how alcohol can leave you with dire side effects.

Alcohol Ingestion, Absorption, & Distribution in the Body

When alcohol is ingested through the mouth, a small amount is immediately broken down in the stomach. Most of the remaining alcohol is then absorbed into the bloodstream from the gastrointestinal tract where alcohol circulating in the blood is transported to the liver, where several enzymes break it down. The activities of these enzymes may vary from person to person, contributing to the observed variations in alcohol elimination rates among individuals. While in the liver, alcohol is metabolized by specific enzymes into acetaldehyde. Acetaldehyde is a toxic substance that may contribute to many of alcohol’s adverse effects (several medications can inhibit these reactions thereby inducing a flushing reaction in all people who consume alcohol after taking those drugs). The acetaldehyde is then transported out of the liver and into the blood system where it is distributed throughout the body. The takeaway message here is: the stronger your New Year’s Eve cocktail, the higher the concentration of alcohol will remain in your circulatory system.

Specific Medication-Alcohol Interactions

Interactions between alcohol and medication can occur in a variety of situations that differ based on the timing of alcohol, drug consumption, gender, weight, and age. Many classes of prescription and non-prescription pain medications can interact with alcohol. The drug classes we would like to discuss are opioids, benzodiazepines, and over-the-counter (OTC) anti-inflammatory agents.

  1. Opioids. Opioids are agents with opium-like effects (e.g. sedation, pain relief, and euphoria) that are used as pain medications. Alcohol enhances opioids’ sedating effects and may cause extreme drowsiness. Consuming large amounts of alcohol and opioids are potentially lethal because they can reduce the cough reflex and breathing functions; as a result, you are putting yourself at risk of getting foods, fluids, or other objects stuck in your airways. Certain opioid pain medications (e.g. codeine, propoxyphene, and oxycodone) are manufactured as combination products containing acetaminophen. These combinations can be particularly harmful when combined with alcohol because they provide “hidden” doses of acetaminophen (see below).
  2. Benzodiazepines. This class is categorized as sedative-hypnotic agents and act through the same brain molecules, as does alcohol. Studies have shown that concurrent consumption of moderate amounts of alcohol while taking a benzodiazepine can cause synergistic sedative effects, leading to substantial central nervous system impairment. It is worth noting that benzodiazepines can impair memory, as can alcohol. Consequently, the combination of these medications with alcohol may exacerbate this memory-impairing effect.
  3. Non-Steroidal Anti-Inflammatory Drugs (NSAID’s). Many people frequently use NSAID’s (aspirin, acetaminophen, ibuprofen, naproxen, indomethacin, and diclofenac) for headaches, minor aches & pains, arthritis, and other disorders of the muscles and bones. Nonetheless, NSAID’s have been associated with an increased risk of ulcers and gastrointestinal bleeding. Alcohol may exacerbate these risks by enhancing the ability of these medications to damage the lining of the stomach. Aspirin, indomethacin, and ibuprofen may cause prolonged bleeding by inhibiting the function of certain blood cells involved in blood clot formation, which is enhanced by concurrent alcohol use. Furthermore, people should be aware that over-the-counter combination cough, cold, and flu medications might contain aspirin, acetaminophen, or ibuprofen, all of which might contribute to serious health consequences when combined with alcohol. Also, alcohol consumption may result in the accumulation of toxic substances (i.e. acetaldehyde). Therefore, patients also using opioid-acetaminophen combination products should be cautioned about restricting the total amount of acetaminophen they ingest daily.

We understand there is quite a bit of medical terminology in each medication-alcohol interactions. In no way is anyone expected to remember all of that information; but what we would like you to remember is that alcohol consumed alongside pain medications can have disadvantageous effects on your physical, mental, and emotional state. By seeking the help of a pain management physician you have made a commitment to live a quality life free of pain, and we salute you! Undertaking activities that deviate from your goal for complete pain relief hurts not only you but also your friends and family. If you’re currently taking any of the medication we mentioned above, alcohol does not have to be in your New Years’ plans to have an excellent time. There are so many alternatives that you could opt for, which not only keep you social but also keep you on the right track for your pain therapeutic regimen. So from us here at Pain Consultants of Arizona, we all wish you and your family a happy New Year! What is an alternative that you turn to rather than alcohol at a party? Let us know and see you in 2017!

Tags: alcohol, pain management, medications, new years, opioids, nsaids, anti-inflammatory


  1. Berkow R, ed. Drugs and the liver. In: The Merck Manual. 16th ed. Rahway, NJ: Merck & Co., Inc;1992:781.
  2. Emanuele, N.V., al. Consequences of alcohol use in diabetics. Alcohol Health & Research World 22(3):211–219, 1998.
  3. Jarzyna D, Jungquist CR, Pasero C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118–145. e10.
  4. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18
  5. Kuffner EK, Dart RC, Bogdan GM, Hill RE, Casper E, Darton L. Effect of maximal daily doses of acetaminophen on the liver of alcoholic patients. A randomized, double-blind, placebo-controlled trial. Arch Intern Med 2001;161:2247-2252.
  6. Levitt, M.D., al. Use of a two- compartment model to assess the pharmacokinetics of human ethanol metabolism. Alcoholism: Clinical and Experimental Research 22:1680– 1688, 1998
  7. Manyike PT, Kharasch ED, Kalhorn TF, et al. Contribution of CYP2E1 and CYP3A to acetaminophen reactive metabolite formation. Clin Pharmacol Ther 2000;67:275-282.
  8. Nemeroff CB, DeVane CL, Pollock BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry. 1996;153(3):311–320.
  9. Niemela, O., al. Early alcoholic liver injury: Formation of protein adducts with acetaldehyde and lipid peroxidation products, and expression of CYP2E1 and CYP3A. Alcoholism: Clinical and Experimental Research 22:2118–2124, 1998.

Why Would I Need To Take A Drug Test For Pain Management?

It’s never a favorable feeling when you feel disconnected from your healthcare management. Unfortunately, there still exists a gap between the treatment/procedures a given patient receives and the patient education and engagement of those treatments. One example that we would bring more insight to is why your pain management doctor may ask for you to provide a urine-drug test. It has been estimated that 20% patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings. From 2007–2012, the rate of opioid prescribing has steadily increased among specialists more likely to manage acute and chronic pain. If you are currently taking an opioid or certain non-opioid pain medications, your doctor may at some point request you provide a urine drug test. So let’s quickly detail what the urine-drug test is and then provide some reasons why it is important to your pain management treatment.

What Is A Urine-Drug Test?

You would be correct in assuming this procedure tests drug levels in the body through a urine sample. But let’s get a little more technical as to the mechanics of a urine-drug test. Once a urine sample is collected, it is sent to a certified laboratory where the sample is analyzed using laboratory methods known as immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection) to yield high detection sensitivity and drug specificity. The test will also determine the concentration of a given medication; the higher the dose of a medication, the higher the concentration will appear on the test. The results are then shipped back to your physician where they will overview the results with you as well as determine what the next step should be in your pain management treatment.

Why Is A Urine-Drug Test Being Done?

There are three main reasons why a urine-drug test is completed for a clinical setting. In general, the test will provide objective evidence and documentation that you are properly taking your medication, and not taking any substance that you are not prescribed. It’s a tool that physicians use to keep you safe, other patients safe, and themselves safe.

  1. Allows your physician to determine the right dose for your medication. When a medication is ingested and absorbed into the blood system, it will travel to the liver where specific metabolic enzymes will convert the medication into its metabolites. These metabolites are what are tested in a urine-drug test. Our DNA dictates as to how [active] our liver enzymes are at metabolizing a drug. Some people are slow metabolizers, meaning it takes longer to form a metabolite; some people are fast metabolizers, meaning a metabolite is formed much more rapid when compared to a normal metabolizer. Let’s use dilauded as an example. Two people are both given a 1mg dose of dilauded. One patient is a slow metabolizer where a lower concentration of dilauded’s metabolites will appear in a urine-drug test when compared to a patient who is normal. Because of a lower concentration of the metabolites, this patient is not receiving the full analgesic-effect of this dose. Thus the physician may determine to either increase the dose or alternate to a different medication.
  2. Determines If You Are Correctly Taking A Drug & Being Honest About It. Misuse of drugs can be accidental or intentional – unfortunately, it can also be fatal. A urine-drug test will report whether you are taking a medication at the prescribed dose and at the proper time. Your physician may decide to remove this medication from your drug therapy or change the dose depending on why the drug was not originally being taken properly.
  3. Determines If You Are Taking Any Illicit or Other Non-Prescribed Drugs. One chronic pain study found that many patients fail to report their drug use, especially illicit drugs. Abusing an illicit or non-prescribed drug can also be fatal, depending on the drugs involved. If potentially fatal drugs are being taken, your physician will do what they can to minimize the risk, and there is no way of telling by looking at a person what the risk for that person is. Because the potential consequences of medication abuse are so serious, i.e. death, your doctor may be required to test a patient who is prescribed an opioid.

We would like to point out that due to the advancements of technology, your doctor may choose to do a saliva, buccal cheek swab, or hair follicle test rather than a urine- test. Although these are different methods, the test still provides the same results so do not be too concerned with the method of testing your doctor may chose to do. Drug testing for opioid or other pain drugs is an important tool that healthcare providers can use to assess drug therapy treatment compliance and opioid misuse; however, no diagnostic test is perfect. It is sometimes possible to “game” the system, and avoid being detected for a while, although who are you really helping with that strategy? If you have trouble managing your medications or your pain, or you are using illegal or non-prescribed drugs, talk to your provider and get help! You don’t have to go it alone.

Tags: urine-drug test, medication, opioids, pain management, healthcare, technology


  1. Centers for Disease Control and Prevention. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26):563-568.
  2. Cone EJ, Caplan YH. Urine toxicology testing in chronic pain management. Postgrad Med. 2009;121(4):91–102
  3. Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010.  Medical Care 2013; 51(10): 870-878.
  4. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Validity of selfreported drug use in chronic pain patients. Clin J Pain. 1999;15(3):184–91.
  5. Frenk SM, Porter KS, and Paulozzi LJ. Prescription Opioid Analgesic Use Among Adults: United States, 1999 – 2012., National Center for Health Statistics Data Brief, February 2015.
  6. Romano G, Barbera N, Lombardo I. Hair testing for drugs of abuse: evaluation of external cocaine contamination and risk of false positives. Forensic Sci Int. 2001;123(2-3):119–129.

Breaking Down Opioids: A Look Into The Controversial Class of Drugs


Opioids are one of the oldest drugs used by humankind. Yet as of today, a lack of understanding can lead to destructive habits, which is finally being noticed by the medical community.2

What Are Opioids?

Opioids are a class of medication where it’s chemical properties act on opioid receptors (specifically MU-receptors) throughout the entire body to elicit morphine-like effects. Your doctor may prescribe you an opioid after lesser effective pain medications have not given pain relief. Thus opioids can be identified as a strong “painkiller” class of drugs.2 Opioids have also gone by other names; for example, an opiate (derived from opium, including morphine) and a narcotic. Not only can the names vary, but also there exist a broad range of medications that are classified as an opioid. Morphine is a potent agonist opioid and is used as the standard for all other opioids. Other well known opioids are semi-synthetic and synthetic drugs such as hydrocodone (Vicodin®), oxycodone (OxyContin®), and fentanyl (Actiq®); and a weaker class of opioids known as antagonists, for example, drugs such as naloxone (Narcane®).3

Even though these drugs are being prescribed at an alarming rate for chronic pain conditions, opioids have been discovered not to be the best choice when combating persistent pain, especially long-term pain.3 The medical community is beginning to agree. As mitigating agency become stricter and guidelines become more rigid; it is rare that a doctor will prescribe an opioid for chronic pain unless it is a cancer-induced pain. So why are the most well known strongest painkillers not the best option?

Figuring It Out The Hard Way

Doctors reducing opioid prescriptions are a relatively new circumstance. From the late 1980s to the early 2000s, medical professionals attempted to aggressively improve the way they treat chronic pain by prescribing opioids for even more people. They believed that prescribing a patient an opioid and having them under observation of a physician would prevent anyone from becoming addicted. This thinking had been quickly proven wrong.4

In reality what the medical community began to observe is that someone taking an opioid can become dependent on the drug in a very short timeframe.

We have all seen opioids as a major story on our news stations. A couple of headlines are:

  • There are 15, 000 to 20, 000 U. S. fatalities per year as a result of an overdose from prescription opioids.5
  • An estimated 2 million people in the United States used opioids recreationally or were dependent on them, during 2014.5
  • Heroin is a less-expensive alternative when addicts can no longer afford their prescription or when they are turned away.5

It Gets Worse

As we have seen, not only are opioids extremely addictive, they have a plethora of side effects. A few examples are: itchiness, sedation, nausea, respiratory depression, constipation, and euphoria, to name a few.1 Recall that opioids taken by chronic pain sufferers for a longer time than is prescribed may begin to offer no pain relief whatsoever. A fascinating quandary also occurs. Yes, it is counterintuitive but overuse of opioids over an extended period can start to cause more pain than before. You can check out our blog on opioid-induced hyperalgesia for more information on this topic. But for now, realize that a drug that is supposed to decrease pain over time can worsen pain if not used according to how it was prescribed.

When Are Opioids Appropriate?

Opioids are highly recommended for acute and short-term pain symptoms. Chronic pain is approached in a different manner. In chronic pain, physicians prescribe this class of drugs usually for cancer-induced pain as well as a VERY last resort for other pain conditions when other therapies have failed. Even then, opioids are prescribed at a very low dose and are usually discontinued as soon as a patient’s condition improves.2

What To Do Next?

If you find yourself in this category, it is wise to consult a pain management expert as soon as possible. The physician will be able to re-evaluate your pain condition and may be able to approach a better prognosis using an alternative medication or method.

Pain management physicians offer an array of even more potentially successful treatments than just prescribing a drug. Talk to your pain management physician as to the best option is for you in cutting down your pain.

Are you currently on an opioid and looking to get off of it? Please come see us and let us help!

Tags: opioids, morphine, addiction, chronic pain, pain management, medication, drugs, painkiller


  1. Benzon, Honorio; Raja, Srinivasa N.; Fishman, Scott E.; Liu, Spencer; Cohen, Steven P. (2011). Essentials of Pain Medicine. Elsevier Health Sciences. p. 85. ISBN 1437735932.
  2. Hemmings, Hugh C.; Egan, Talmage D. (2013). Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application: Expert Consult – Online and Print. Elsevier Health Sciences. p. 253. ISBN 1437716792.
  3. Offermanns, Stefan (2008). The natural products morphine, codeine, thebaine and many semi-synthetic congeners derived from them Encyclopedia of Molecular Pharmacology 1 (2 ed.). Springer Science & Business Media. p. 903.
  4. “Report III: FDA Approved Medications for the Treatment of Opiate Dependence: Literature Reviews on Effectiveness & Cost- Effectiveness, Treatment Research Institute”. Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment. p. 41.
  5. “Status and Trend Analysis of Illicit Drug Markets”. World Drug Report 2015 (PDF). Retrieved 26 June 2015.

When Medication Inflames The Problem: A Look At Hyperalgesia

The use of pain relief medications as well as other classes of similar medications is the most common routine when treating chronic pain conditions. Common and widely prescribed classes of pain medications are opioids, such as morphine or oxycodone.2, 7, 9 Opioids can vary from strong to weak and are prescribed according to what your physician deems appropriate, given your condition.1 Patients vary as to how effective a given pain medication works, whether it be strong relief to no relief whatsoever. Yes, pain medications are helpful for many patients, but they are not unanimously effective. In fact, pain medications may sometimes exacerbate someone’s symptoms overtime causing undesirable effects.2-6

It is well documented that long-term use of opioids may cause increased risked for constipation, hormone dysfunction, and memory/affect dysfunction to name a few.7-9 After extreme long-term use, there can actually be a reversal of an opioid’s effect where a patient’s pain actually increases. Such a condition is known as opioid-induced hyperalgesia (OIH).1-12

Opioid Induced Hyperalgesia

The main job of opioids is to block or activate certain receptors in the brain resulting in pain relief. However, in some cases opioids actually have the opposite effect where taking an opioid can increase the pain someone feels. For example, a mild sensation as being patted on the back may feel as extreme pain for someone suffering from (OIH).9, 10 (OIH) will likely cause an increase in the severity of their chronic pain condition; unfortunately they may also begin to feel pain in different parts of their body where there was not pain beforehand.5-7

Studies in humans have discovered that a higher dose of opioids during surgery is associated with greater post-operative pain (i.e. OIH) after those opioids have broken down.2, 3 Unfortunately, (OIH) is not limited only to surgery and can also occur while a person is still taking opioids on a daily basis. Though the occurrence of (OIH) is not well documented, doctors believe it is more prevalent than once thought, and as stated above, is more commonly seen in those patients who are taking a higher dose over a long period of time.5 In one trial, 23 patients were studied who experienced severe pain (8/10 on average) who felt no relief from high doses of opioids. Over the course of weeks, each patient was slowly taken off his or her opioid. The study discovered that these patients’ pain decreased to an average of about 3/10 after stopping their opioids, with 21 of the 23 patients experiencing reduced pain.8 Doesn’t make sense, right?

Why does opioid induced hyperalgesia occur?

(OIH) occurs as a result of the body adapting to the effects of an opioid. As a result, the central nervous system changes. These changes result in several neural systems, that normally regulates the perception of pain, to become overactive in response to the action of an opioid. The over-activity of these neural systems can block out or even surpass the pain relieving effect of the drug. The increase in pain may perpetuate until the opioid is discontinued.1-3, 6

What can be done for opioid induced hyperalgesia?

Only your provider can determine if you have (OIH), as several other conditions may have similar symptoms. In many cases when a patient is experiencing OIH, reducing or even eliminating opioids can produce a substantial reduction in pain. In other cases, switching to a different opioid may be effective in reversing OIH and restoring pain relief.6, 8

Have you dealt with symptoms of Opioid Induced Hyperalgesia? Let us know!

Tags: hyperalgesia, opioids, chronic pain, pain management, nervous system


  1. Angst, Martin S.; Clark, J David (2006). “Opioid-induced Hyperalgesia”. Anesthesiology. 104 (3): 570–87. doi:1097/00000542-200603000-00025. PMID16508405.
  2. Célèrier, E; Laulin, JP; Corcuff, JB; Le Moal, M; Simonnet, G (2001). “Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process”. The Journal of Neuroscience. 21 (11): 4074–80. PMID11356895.
  3. Chen, Lucy, et al. “Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia.” Journal of opioid management 10.6 (2013): 383-393
  4. Chu, Larry F.; Angst, Martin S.; Clark, David (2008). “Opioid-induced Hyperalgesia in Humans”. The Clinical Journal of Pain. 24 (6): 479–96.
  5. Fine PG (2004). “Opioid insights:opioid-induced hyperalgesia and opioid rotation”. J Pain Palliat Care Pharmacother 18 (3): 75–9. doi:10.1080/J354v18n03_08 . PMID 15364634
  6. Lee, SH; Cho, SY; Lee, HG; Choi, JI; Yoon, MH; Kim, WM (2013). “Tramadol induced paradoxical hyperalgesia”. Pain Physician. 16 (1): 41–4.
  7. Mao, Jianren (2002). “Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy”. Pain. 100 (3): 213–7.
  8. Mercadante S, Arcuri E (2005). “Hyperalgesia and opioid switching”. Am J Hosp Palliat Care 22 (4): 291–4. doi:10.1177/104990910502200411 . PMID 16082916
  9. Mitra, S. “Opioid-induced hyperalgesia: pathophysiology and clinical implications.” Journal of opioid management 4.3 (2007): 123-130.
  10. Reznikov I. et. al. “Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain.” British journal of clinical pharmacology 60.3 (2005): 311-318.
  11. Vella-Brincat J, Macleod AD (2007). “Adverse effects of opioids on the central nervous systems of palliative care patients”. J Pain Palliat Care Pharmacother. 21 (1): 15–25. doi:1080/J354v21n01_05. PMID17430825.
  12. Wilson GR, Reisfield GM (2003). “Morphine hyperalgesia: a case report”. Am J Hosp Palliat Care. 20 (6): 459–61.