• Jarred Younger, Peter Barelka, Ian Carroll, Kim Kaplan, Larry Chu, Ravi Prasad, Ray Gaeta, and Sean Mackey.
• Stanford University School of Medicine, Department of Anesthesia, Division of Pain Management, Palo Alto, California 94304-1573, USA. Jarred.Younger@stanford.edu
• Pain Med. 2008 Nov 1; 9 (8): 115811631158-63.

ObjectiveOne 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.DesignTwelve 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 The majority of participants were completely withdrawn from their opioids during their stay.Outcome MeasuresWe hypothesized that those patients with the greatest reduction in daily opioid use would show the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tolerance, as assessed by a cold pressor task.ResultsA linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized.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.ConclusionsThese findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.

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