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ilovemybrownies t1_jef15rw wrote

Paradoxically, a small percentage of people who regularly use opioids develop Opioid Induced Hyperalgesia (OIH), which means they basically become sensitized to their own pain.

The current theory about the mechanism is that certain parts of the major pain pathways in your nervous system gain a unique tolerance to the drug's pain relief effects. I'm probably oversimplifying, but it's a real phenomenon and not very well understood.

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Foxs-In-A-Trenchcoat t1_jefl3mo wrote

I heard they actually grow more pain receptors the longer they're on opioids.

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dandan_oficial t1_jefqwma wrote

which thinking about it makes sense, because when the body is too insensitive to things it might try to feel them again, and for that it'll develop more pain receptors... Just a thought.

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Iron_Garuda t1_jefsh2f wrote

Are you aware if it’s a reversible phenomenon?

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ilovemybrownies t1_jefu3on wrote

Thankfully if you stop using long enough it does seem to go away for many people. Some studies suggest it's reversible in the sense that your pain receptors may "reset" their tolerance after roughly 5-6 months of abstinence from the drug. Sometimes doctors have success just rotating opioids in their patient's med schedule and using other pain meds in-between.

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Apprehensive_Fuel873 t1_jeg74tn wrote

Well we already know of things that "heighten" pain in more mundane contexts like putting salt or antiseptic cream on a wound, but I don't know if the process is related/similar.

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barbzilla1 t1_jeg5ch0 wrote

That's primarily because opiates themselves have very weak analgesic properties. This is why most prescription opiates come with acetaminophen or APAP, as it is one of the most effective analgesics. What the opiates do however, is dump a ton of dopamine on your neurotransmitters causing you to care less about the pain that you were already in. For some reason after perceiving less pain you'll actually start to feel less pain too, and I don't just mean on the short term there is an actual correlation between accepting the pain and lessening the pain

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Vergilx217 t1_jeg92nw wrote

...this isn't very correct

Opioids are certainly considered very potent analgesics because of their interactions with the μ, κ, and δ receptors. These generally work through inducing secondary messengers like cAMP to block calcium channels and activate potassium channels, which usually makes it much more difficult for pain sensing neurons to transmit signals. The underlying pathology of addiction is related to dopamine release in the addiction centers like the VTA, but that's certainly different from how pain is actually blocked.

Tylenol is also not a particularly strong analgesic by any stretch, but it works by inhibiting inflammatory pathways. It's often given in conjunction with opioids because it can reduce swelling and discomfort that isn't strictly pain.

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barbzilla1 t1_jeh2lnf wrote

Your understanding seems more complete than mine so anybody else reading this listen to this guy. Mine is just armchair knowledge from studying my own medical issues.

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International_Bet_91 t1_jegcumi wrote

This is wrong.

Acetaminophen is a level 1 (weak) analgesic. Opioids are level 2 or the 3 depending on the drug. Level 3 is the highest level.

https://www.ncbi.nlm.nih.gov/books/NBK554435/

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barbzilla1 t1_jeglpd2 wrote

When they are speaking of pain meds here they are testing responsiveness to said pain using the hotplate test with mice. While it has an analgesic property as it brings relief, it is not lessening nerve signals as the topic was about. I realize I'm using layman's terminology, but there are many plants with much better allergies and effects as far as reducing nerve signal. Such as Tylenol and aspirin, so honestly the gold standard is cone snail toxin but most people are prescribed either gabapentin or Lyrica.

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AAA515 t1_jegvr3u wrote

What is this hotplate test and why do I not like it already?

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barbzilla1 t1_jeh2h6l wrote

They set the temperature of a scientific hotplate to the level painful but not physically damaging to lab mice, then administer a combo of whatever drug they are testing and a control/placebo to various mice, they then place said mice in said hotplate and time the pain reaction. The mice usually get used for between a week and a month then are either dissected or disposed of.

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