Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report
Abstract. Introduction and objectives:. Understanding the details of one individual's experience with pain, opioid use and withdrawal may generate insights into possible relationships between opioid-induced hyperalgesia and withdrawal-associated injury site pain (WISP). Methods:. This case stud...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2018-06-01
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| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000648 |
| _version_ | 1818701818177257472 |
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| author | Launette Marie Rieb Wendy V. Norman Ruth Elwood Martin Jonathan Berkowitz Evan Wood Michael John Milloy Ryan McNeil |
| author_facet | Launette Marie Rieb Wendy V. Norman Ruth Elwood Martin Jonathan Berkowitz Evan Wood Michael John Milloy Ryan McNeil |
| author_sort | Launette Marie Rieb |
| collection | DOAJ |
| description | Abstract. Introduction and objectives:. Understanding the details of one individual's experience with pain, opioid use and withdrawal may generate insights into possible relationships between opioid-induced hyperalgesia and withdrawal-associated injury site pain (WISP).
Methods:. This case study was extracted from a mixed methods study that characterized WISP. In 2014, the individual was recruited from a primary care clinic that prescribes opioid agonist therapy. In an interview, she completed a 35-item survey and elaborated on her own experience. Follow-up contact was made in June of 2017.
Results:. This 34-year-old white woman had several twisting injuries of her right knee between ages 13 and 15. The pain resolved each time in a few days, and she was pain free for 15 years. Around age 30, she initiated illicit oxycodone recreationally (not for pain) and developed an opioid use disorder. On detoxification, she experienced severe knee pain for 6 weeks that resolved postdetoxification but returned after subsequent oxycodone use and withdrawal episodes along with generalized skin sensitivity. This experience of WISP became a barrier to opioid cessation. Although nonsteroidal anti-inflammatories and gabapentin relieved WISP and methadone therapy assisted her opioid use disorder, an eventual change to sublingual buprenorphine/naloxone provided superior control of both.
Conclusion:. This case report illustrates that both opioid use and withdrawal can reactivate injury site pain, which can increase with dose escalation and repeated withdrawal events. The timing, trajectory, and neuropathic features of WISP reported here are consistent with those previously reported for the development of opioid-induced hyperalgesia, possibly linking these phenomena. |
| first_indexed | 2024-12-17T15:26:53Z |
| format | Article |
| id | doaj.art-b962ac8405fa49a2bb25107892b8daa9 |
| institution | Directory Open Access Journal |
| issn | 2471-2531 |
| language | English |
| last_indexed | 2024-12-17T15:26:53Z |
| publishDate | 2018-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | PAIN Reports |
| spelling | doaj.art-b962ac8405fa49a2bb25107892b8daa92022-12-21T21:43:15ZengWolters KluwerPAIN Reports2471-25312018-06-0133e64810.1097/PR9.0000000000000648201806000-00006Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case reportLaunette Marie Rieb0Wendy V. Norman1Ruth Elwood Martin2Jonathan Berkowitz3Evan Wood4Michael John Milloy5Ryan McNeil6aDepartment of Family Practice, University of British Columbia, Vancouver, BC, CanadaaDepartment of Family Practice, University of British Columbia, Vancouver, BC, CanadaaDepartment of Family Practice, University of British Columbia, Vancouver, BC, CanadacSauder School of Business, University of British Columbia, Vancouver, BC, CanadadBC Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, CanadadBC Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, CanadadBC Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, CanadaAbstract. Introduction and objectives:. Understanding the details of one individual's experience with pain, opioid use and withdrawal may generate insights into possible relationships between opioid-induced hyperalgesia and withdrawal-associated injury site pain (WISP). Methods:. This case study was extracted from a mixed methods study that characterized WISP. In 2014, the individual was recruited from a primary care clinic that prescribes opioid agonist therapy. In an interview, she completed a 35-item survey and elaborated on her own experience. Follow-up contact was made in June of 2017. Results:. This 34-year-old white woman had several twisting injuries of her right knee between ages 13 and 15. The pain resolved each time in a few days, and she was pain free for 15 years. Around age 30, she initiated illicit oxycodone recreationally (not for pain) and developed an opioid use disorder. On detoxification, she experienced severe knee pain for 6 weeks that resolved postdetoxification but returned after subsequent oxycodone use and withdrawal episodes along with generalized skin sensitivity. This experience of WISP became a barrier to opioid cessation. Although nonsteroidal anti-inflammatories and gabapentin relieved WISP and methadone therapy assisted her opioid use disorder, an eventual change to sublingual buprenorphine/naloxone provided superior control of both. Conclusion:. This case report illustrates that both opioid use and withdrawal can reactivate injury site pain, which can increase with dose escalation and repeated withdrawal events. The timing, trajectory, and neuropathic features of WISP reported here are consistent with those previously reported for the development of opioid-induced hyperalgesia, possibly linking these phenomena.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000648 |
| spellingShingle | Launette Marie Rieb Wendy V. Norman Ruth Elwood Martin Jonathan Berkowitz Evan Wood Michael John Milloy Ryan McNeil Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report PAIN Reports |
| title | Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report |
| title_full | Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report |
| title_fullStr | Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report |
| title_full_unstemmed | Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report |
| title_short | Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report |
| title_sort | linking opioid induced hyperalgesia and withdrawal associated injury site pain a case report |
| url | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000648 |
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