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Hyperalgesia—A Blessing in Disguise for Opioid Users

We know the danger of long-term, unnecessary opioid use:

  • Respiratory depression
  • Drowsiness
  • Lethargy
  • Paranoia
  • Nausea
  • Constipation
  • Decreased sexual function
  • Death

And the list goes on. But the one side effect of opioids that long-term users don’t believe is increased pain. Hyperalgesia, as it is termed, affects about 25% of the injured workers we see. Once these patients have been convinced that tapering off the medication is truly in their best interests, they are amazed at the results.

We can’t know if an injured worker has hyperalgesia until he starts to eliminate the opioids. In the case of these particular individuals, the tapering process is fairly easy.


Hyperalgesia is a heightened sensitivity to pain that occurs due to changes in the nervous system. Think of it like a mosquito bite. The neurotransmitters in the bite cause the itching response that stimulates the scratching behavior that inflames the cycle of itch and scratch. In the case of hyperalgesia, opioids cause an enhanced pain response. Of course, the person doesn’t realize it and instead seeks more of the drugs to address the heightened pain. We know this is most likely the effect when an injured worker walks into our office a week after tapering off his opioids and announces he feels great! Never better.

What to Do

Injured workers with hyperalgesia are more fortunate than others on long-term opioid therapy in that the positive effects of being off the drugs are experienced almost immediately. While others may go through various types of withdrawal symptoms, injured workers with hyperalgesia may have few, if any before they’re already feeling better. Regardless of how easy it is for them to wean, they still need to be monitored as they taper off the medications. There may be other factors going on and other withdrawal symptoms may be present. By and large though, they are the quickest to resume living productive lives.


Opioid users with hyperalgesia have a relatively easy time weaning off the drug. Once weaned, they find they feel better than ever.

IMCS is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.