Pain Tolerance and Narcotic Addiction

Martin, Judith E.; Inglis, James

doi:10.1111/j.2044-8260.1965.tb00467.x

Cited by 72 publications

(27 citation statements)

References 5 publications

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“…Notably, Cortinez et al [13] reported contradictory results under similar conditions. Several other observations have suggested that opioid-addicted subjects differ in their sensitivity to pain compared with normal subjects [14,15]. In a recent small study, Compton et al [16] found shorter withdrawal latencies for cold-pressor pain in opioid addicts maintained on methadone and buprenorphine, as compared with a non-opioid treated control group, indicating that prolonged opioid use in that population may enhance abnormal pain sensitivity.…”

Section: Introductionmentioning

confidence: 96%

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Reznikov

Pud

Eisenberg

2005

Brit J Clinical Pharma

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AimsPrevious research has reported on reduced paw withdrawal latencies to heat and mechanical stimuli after parenteral administration of opioids in animals and on increased pain sensitivity in humans subsequent to postoperative infusions of shor tacting opioids or in drug addicts. The aim of the present study was to explore the possibility that oral opioid treated patients with cancer-related or chronic nonmalignant pain differ in their pain sensitivity from patients treated with non-opioid analgesics. MethodsThe study population consisted of 224 patients, including 142 in the opioid-treated group and 82 in the non-opioid-treated group. Pain thresholds for punctuate measured by von Frey filaments (g), mechanical pressure measured by pressure algometer (mmHg), heat stimuli measured by quantitative sensory testing ( ∞ C), as well as suprathreshold tonic heat pain intensity (46.5 ∞ C for 1 min) measured by 0-10 numerical pain scale (NPS) were obtained at a nonpainful site (thenar eminence) in all patients. ResultsNo differences between the groups were found for gender, age, duration of pain, or duration of treatment (independent variables). No significant differences between the groups were found in punctuate (difference = 17.0 g (95% CI -8.8, 42.8), P = 0 . 19), pressure (2.2 mmHg ( -28.7, 33.2), P = 0.89) and heat ( -0.3 ∞ C ( -1.5, 0.9), P = 0 . 70) pain thresholds, or in suprathreshold heat pain intensity (difference between maximal pain intensities -0.4 NPS units (95% CI -1.2, 0.4), P = 0.31). Pearson correlations within the opioid-treated group failed to show significant relationships between any of the independent variables and the outcome measures. A further comparison of the outcomes between the 'weak' opioid-treated subg roup and the 'strong' opioid-treated subgroup again revealed insignificant results. ConclusionsThese results suggest that the administration of 'commonly used' dosages of oral opioids does not result in abnormal pain sensitivity beyond that of patients receiving non-opioid analgesia.

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Section: Introductionmentioning

confidence: 96%

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Reznikov

Pud

Eisenberg

2005

Brit J Clinical Pharma

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“…On the other hand, pain can also be a result of chronic opiate use. OAs exhibit hyperalgesia after long-term opiate use, as shown by significantly shorter durations of ability to withstand immersion of the hand in ice-cold water compared to healthy individuals (Compton 1994; Compton et al 2001; Martin and Inglis 1965; Pud et al 2006). Patients on methadone maintenance are relatively intolerant of pain, a finding hypothesized to reflect a hyperalgesic state induced by chronic opiate administration (Compton et al 2001).…”

Section: Introductionmentioning

confidence: 99%

Abnormal pain response in pain-sensitive opiate addicts after prolonged abstinence predicts increased drug craving

et al. 2009

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Rationale Craving is a primary feature of opiate addiction and is clinically significant because of its potential to trigger opiate use and relapse. Opiate use can also produce abnormal pain perception. We predicted that for opiate addicts (OAs), there may be an association between these two major features of addiction (drug craving and abnormal pain responses). Objectives To examine pain responses in abstinent opiate addicts in comparison with healthy controls using a cold-pressor test (CPT) and investigate the correlations of cue-induced drug craving with pain responses. Material and methods Fifty-four abstinent OAs and 46 healthy subjects participated in the CPT, and the OAs were also exposed to heroin-related cues the day before the pain test. Outcome measures included pain-tolerance time, VAS ratings of pain intensity and distress, and (in the cue-exposure procedure) VAS ratings of heroin craving and anxiety. Results In the CPT, abstinent addicts showed shorter pain-tolerance time (85.1±14.1 s vs. 133.7±16.7 s, p<0.05) and higher ratings of pain distress (61±3.2 vs. 45.6±3.2, p< 0.01) compared to healthy controls. When we divided the addicts and controls into pain-sensitive (PS) and pain-tolerant (PT) groups by dichotomizing each group in terms of pain-tolerance time, we again found differences between the two PS groups (37.3±3.5 s vs. 57.4±5.1 s, p<0.01 for pain-tolerance time; 66.7±3.2 vs. 52.4±3.3, p<0.01 for distress ratings). For all participants, pain-tolerance time was negatively correlated with VAS ratings for pain intensity and distress. More importantly, the PS addicts reported greater cue-induced craving than the PT addicts (17.8±2.2 vs. 4.5±4.2, p<0.05). For the addict group as a whole, pain distress (the affective aspect of pain) was positively correlated with intensity of cue-induced craving measured on a different day (r=0.33, p=0.01). Conclusions A hyperalgesic state persists for at least 5 months in abstinent OAs and is predictive of cue-induced craving. Longitudinal research is needed to clarify the direction of causation between hyperalgesia and opiate addiction.

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“…32 BPD patients often report dysphoria and the amplitude of this may be a good marker for this diagnosis. 33 More than forty years ago, Martin and Inglis 34 noted that some patients addicted to opioids might take opioid drugs because of “an abnormally low tolerance for painful stimuli.” It seems possible that a subset of people with borderline personality have low tolerance for pain and that their emotional distress further lowers their tolerance.…”

Section: Discussionmentioning

confidence: 99%

The Use of Prescription Opioid Medication by Patients With Borderline Personality Disorder and Axis II Comparison Subjects

Frankenburg

Fitzmaurice²,

Zanarini³

2014

J. Clin. Psychiatry

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Objective-The first purpose of this study was to determine the rate of use of prescription opioid medication reported by patients with borderline personality disorder (BPD) and to compare that to the rate reported by axis II comparison subjects during a 10-year period of prospective follow-up. The second purpose of this study was to determine the most clinically relevant predictors of prescription opioid use among borderline patients.Method-The medical conditions and axis I disorders of 264 borderline patients and 63 axis II comparison subjects were assessed at six-year follow-up and five contiguous follow-up waves that were two years apart. These assessments were conducted between July 1998 and December 2010. Family history of psychiatric disorder had been assessed at baseline by interviewers blind to the diagnostic status of the subjects. All three areas were assessed using semistructured interviews with proven psychometric properties: the Medical History and Services Utilization Interview (MHSUI), the Structured Clinical Interview for DSM-III-R Axis I disorders (SCID I), and the Revised Family History Questionnaire (FHQ-R).Results-Borderline patients were significantly more likely to report the use of prescription opioid medication over time than axis II comparison subjects (OR=1.79; 95%CI, 1.01-3.17). The best predictors of opioid use among borderline patients were the time-varying presence of back pain (OR=1.95; 95%CI, 1.41-2.70), fibromyalgia (OR=3.29; 95%CI, 1.70-6.36), and osteoarthritis (OR=3.32; 95%CI, 2.08-5.29) as well as a baseline history of drug abuse (OR=1.89; 95%CI, 1.27-2.81).Conclusions-The sustained use of prescription opioids is common among and discriminating for patients with BPD. The results also suggest that these borderline patients may be particularly sensitive to physical pain-mirroring their well-known heightened sensitivity to emotional pain.Address correspondence to Dr. Frankenburg, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478; phone: 781-687-3004; fax: 617-855-3580; Frances.Frankenburg@med.va Other problems with opioid medications include side effects such as constipation, drowsiness, and decreased libido. Over time, the analgesic efficacy may not be maintained. 4 Chronic opioid use can also increase sensitivity to pain. 5,6 Ever since the work of Portenoy and Foley, the rates of opioid addiction among pain patients have been thought to be very low. Fishbain et al. 7 reviewed over 67 studies of opioid treatment of nonmalignant pain and found that of 2500 patients just over 3% developed abuse or addiction. The rates were lower if subjects were not treated if they had any current or previous history of abuse or addiction. Urine toxicology, however, revealed a higher number of problems. For example, some patients had no opioids in their urine suggesting possible diversion of these medications. In general, the rates of addiction to prescription opioids are higher if the patient has a history of substance abuse, comorbid mental illness, or somatization, or i...

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Pain Tolerance and Narcotic Addiction

Cited by 72 publications

References 5 publications

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Abnormal pain response in pain-sensitive opiate addicts after prolonged abstinence predicts increased drug craving

The Use of Prescription Opioid Medication by Patients With Borderline Personality Disorder and Axis II Comparison Subjects

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