Opioids are commonly prescribed for severe pain, but over time they may cause more problems than they solve.
While opioids are powerful pain relievers, prolonged use can alter the body’s pain pathways and, paradoxically, increase pain sensitivity.
Opioids are a class of medications used to relieve moderate to severe pain by binding to specific receptors in the nervous system and other parts of the body. Common examples include morphine, oxycodone, and codeine. When used appropriately, opioids can be effective for short-term pain relief; however, long-term use can lead to dependence and a range of side effects that may complicate recovery.
Opioid-induced hyperalgesia (OIH) is a condition where prolonged or high-dose opioid use paradoxically increases pain sensitivity rather than relieving it. This paradox leaves patients stuck in a cycle of worsening pain and increasing medication use — often without clear recognition that opioids may be part of the problem.
When opioid use paradoxically amplifies pain sensitivity, creating a cycle where more medication leads to greater discomfort
OIH occurs when opioids alter pain pathways, lowering pain thresholds and heightening sensitivity. Neural systems become sensitised (central sensitisation), resulting in increased pain despite escalating doses.
OIH risk increases with high-dose or long-term opioid use, particularly with potent opioids like morphine, oxycodone and fentanyl. Genetic predisposition, rapid dose escalation, concurrent NMDA receptor activation, sleep deprivation, and underlying pain sensitisation further amplify risk. Patients with chronic pain or psychological stress are also more susceptible.
Distinguishing OIH from tolerance or disease progression can be difficult
OIH can often mimic worsening of the original pain condition. However, certain patterns can suggest that opioids may be amplifying, rather than relieving, pain:
We use evidence-based therapies that can address OIH and aim to reduce opioid use
Our advanced therapies can reduce opioid induced heightened pain sensitivity, support safe opioid reduction, and help patients regain quality of life.
Ketamine therapy interrupts abnormal pain signalling and calms central sensitisation, reducing hyperalgesia and improving function. It can also assist in reducing opioid use, provide relief during opioid tapering and ease withdrawal-related pain flare-ups.
Stellate Ganglion Block (SGB) may help patients whose OIH is compounded by certain pain conditions related to sympathetic overactivity and stress-related amplification.
Managing opioid induced hyperalgesia requires more than reducing medication — it requires restoring balance to the nervous system.
At Anodyne, we assess each patient’s pain profile carefully and use evidence-based treatments to help recalibrate the body’s pain pathways and restore effective pain control.
We recognise how discouraging it can be when pain worsens despite higher medication doses.
We offer safe, evidence-based care for people experiencing OIH and treatment-resistant pain. Our therapies aim to not only reduce pain sensitivity but also help patients move forward with less reliance on opioids.
Take the next step
If you suspect opioids may be making your pain worse, advanced alternatives are available. Book an appointment or make an enquiry to discuss whether ketamine therapy or a tailored reduction plan may be right for you.
