Opioid induced hyperalgesia treated with low dose naltrexone improves pain

Abstract Opioids are prescribed for 5 – 8 million Americans with chronic pain 1 and many more worldwide. For patients currently on chronic opioid therapy (COT) continuation of opioids is recommended because of mental health crises and overdoses that occur during medication taper 2 and because of deaths associated with accidental overdose when opioid medications are discontinued. 3, 4 Because opioid medications are exogenous opioid hormones that downregulate the pain damping opioid receptor system and upregulate pain drivers, opioid induced hyperalgesia (OIH) is a near-universal finding when the cold pressor test (CPT) is used to measure pain tolerance. 5 Detoxification is best accomplished with a single dose of buprenorphine immediately followed with low dose naltrexone (LDN). LDN treats OIH. We conducted a retrospective chart review of patients treated on our pain service from 2011 through 2022. Short CPTs improved with detoxification and LDN. Pain diminished. Our results show that opioid medications are contraindicated for chronic pain. Patients currently prescribed daily opioid medications can safely be detoxified and have their centrally mediated pain treated with LDN, using the CPT to track resolution of OIH. Psychotherapy is necessary in many instances because opioids attenuate feelings and distort relationships.