Abstract
Evidence suggests that patients on opiate maintenance therapy for the treatment of
addiction present with opioid-induced hyperalgesia. This study compared the experimental
(cold-pressor, electrical stimulation) pain responses of 82 treatment-seeking heroin-dependent
adults, randomized to methadone (METH, n = 11) or buprenorphine (BUP, n = 64) therapy,
with matched drug free controls (n = 21). Heroin-dependent participants were evaluated
at baseline (treatment entry), medication (METH or BUP) stabilization (4–8 weeks),
and chronic administration (12–18 weeks), at trough (just prior to dosing) and peak
(3 hours after dosing) plasma levels. Collection of the control group’s pain responses
occurred twice during a single session, 3 hours apart. Baseline comparisons indicate
that heroin-dependent individuals demonstrate significantly shorter latencies to threshold
and tolerance for cold-pressor pain than the control group. Across pain stimuli and
time points, little change in pain responses was found over time, the exception being
cold pressor pain tolerance, for which hyperalgesia significantly increased at trough
METH/BUP levels in both groups as they stabilized in treatment. We conclude that heroin-dependent
individuals are hyperalgesic, and that once stabilized in treatment, are not different
in pain responses regardless of treatment agent. The effects of nonpharmacologic therapy
and previous heroin use may explain increased hyperalgesia found with treatment.
Perspective
To better understand the clinical phenomenon of opioid-induced hyperalgesia, this
article describes experimental pain responses of heroin-dependent participants both
prior to and over the course of maintenance therapy with methadone or buprenorphine.
Hyperalgesia is present with illicit and treatment opioid use, and does not appear
to appreciably improve over the course of treatment.
Key words
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Article info
Publication history
Published online: March 19, 2012
Accepted:
January 13,
2012
Received in revised form:
December 19,
2011
Received:
August 13,
2011
Footnotes
Funding for study expenses and subject payment was provided by NIDA grant DA13706.
No conflicts of interest exist.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
