Hyperalgesia is an increased response of the nervous system to any stimulus, resulting in intense pain. It can be caused by physical injury, platelet activating factor, or long-term opioid use. Treatment is difficult and often involves testing different drug combinations.
Hyperalgesia is a phenomenon that creates an increased response of the nervous system to any stimulus. This reaction is so intense that the human brain interprets these signals as intense pain. It can be experienced in focal areas or more generally, to the whole body. There have been numerous conditioning studies that have shown that it is possible to suffer from learned hyperalgesia.
There are two types of focal hyperalgesia which are normally the result of some type of physical injury. Primary hyperalgesia exists when pain sensitivity occurs directly in damaged tissue, while the secondary form is pain sensitivity that occurs in peripheral nerves that were not damaged during the injury. Normally this is because there was some damage to the surrounding sensory receptors, or nociceptors. There is also opioid-induced hyperalgesia which can develop as long-term opioid use. This normally occurs because opioids have been used to treat chronic pain.
The specific mechanisms that cause hyperalgesia vary and, in some cases, are poorly understood. It is most commonly caused by platelet activating factor (PAF), which is the body’s normal response to allergies or muscle inflammation. Essentially, immune cells interact with the peripheral nervous system and release cytokines and chemokines, which are hormones that produce pain. Hyperalgesia can also be caused by pain fibers in the body being stimulated in the same pattern as inflammation. This will create an amplification of pain fiber synapses through the nerves of the spinal cord.
People who have been exposed to opioids such as oxycodone or heroin over a long period of time are at risk of opioid-induced hyperalgesia. Opioids are commonly used to treat chronic pain, and when a person reports higher pain levels than the physical findings indicate, they will often increase the dosage instead of being treated for hyperalgesia. The constant overstimulation of opioid receptors will therefore result in an altered level of homeostasis in pain signaling pathways.
Hyperalgesia demonstrates a similarity to other types of pain disorders that are better understood, such as allodynia. This condition, in all its forms, is not fully understood and does not have its own standardized treatment, so most people will be treated as if they have allodynia. This means they have the option of using a variety of medications, including tricyclic antidepressants, pregabalin, tramadol, and others. From a clinical perspective, creating a treatment regiment is very difficult because it relies on testing a number of drug combinations until one works. In the case of opioid-induced hyperalgesia, there is a possibility that simply decreasing opioid dosage levels could lead to improvement.
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