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Is it possible that opioids actually help to maintain a state of persistent pain?
Even a single dose of opioids causes hyperalgesia - that has been shown pretty clearly in the peri-operative setting.
SP Cohen's cool and elegant article showed us that practically EVERYONE on opioids, in a dose dependent fashion develop hyperalgesia.
We know from State of Washington's studies that if a patient gets on opioid on presentation to the ER for back injury/pain, that independently predicts that they won't return to work 1 year later.
We know that opioids act directly on glial cells causing a decrease in spinal pain inhibition, and increases receptor-field expansion.
So, is it possible that giving someone opioids actually makes or helps the pain state persist? If someone has surgical trespass, and is given opioids - and they stay on it longer than would be expected - could the opioids be the culprit in preventing the pain inhibitory system to kick in and do its thing?
Even a single dose of opioids causes hyperalgesia - that has been shown pretty clearly in the peri-operative setting.
SP Cohen's cool and elegant article showed us that practically EVERYONE on opioids, in a dose dependent fashion develop hyperalgesia.
We know from State of Washington's studies that if a patient gets on opioid on presentation to the ER for back injury/pain, that independently predicts that they won't return to work 1 year later.
We know that opioids act directly on glial cells causing a decrease in spinal pain inhibition, and increases receptor-field expansion.
So, is it possible that giving someone opioids actually makes or helps the pain state persist? If someone has surgical trespass, and is given opioids - and they stay on it longer than would be expected - could the opioids be the culprit in preventing the pain inhibitory system to kick in and do its thing?