Alternative Pain Management: Can Opiates Decrease Pain Tolerance?

For years doctors have been prescribing opiates to treat pain, but new studies are finding that people who have been using opiates/opioids to treat pain may have decreased pain tolerance. This leads to more opiate use- sometimes resulting in addiction the detrimental consequences that result. Here is an article regarding opiates and their role in pain tolerance over time.

"There are many drugs that act as a form of anesthesia – a drug or substance that makes one less sensitive to pain. In history, many times whiskey was used to make one less sensitive to pain. A folk medicine used by my grandmother involved adding a small amount of whiskey to some hot water to treat coughs.

A more common example of an anesthetic in use today is novocaine. In order to lessen the pain that comes from the dentist drilling into a tooth to fill a cavity, the dentist gives you a shot of novocaine. Of course, if you were given the novocaine but the dentist did not repair the tooth, the pain would return when the effects of the novocaine wore off. The tooth would continue to decay even if the dentist kept giving you novocaine to lessen the pain.

There are many comparisons to the medical use of opioids. A person recovering from surgery will likely have pain while the body heals. If the person takes opioids then this, like novocaine, will lessen the pain. After a time, the person can stop taking the opioids.

Too often, if a person is suffering from pain and goes to see many medical doctors, there is only a cursory attempt to find the actual cause of the pain. The “treatment” that they give is to prescribe opioids. Unfortunately, since the cause of the pain has not been addressed, the underlying problem will almost always get worse. This form of medical treatment would be like the dentist never finding the tooth that was creating the pain and just administering novocaine.

The most prescribed opioids are:

  • OxyContin
  • Oxycodone
  • Morphine
  • Methadone
  • Hydrocodone
  • Vicodin
  • Percocet
  • Lortab
  • Fentanyl Patch


Many people who are prescribed opioids, like OxyContin, for pain find that they have to continually increase the dosage of opioids they take in order to get the same pain relief.

In some cases, this increase in opioid dosage was required because the opioid receptors became less sensitive to the opioids, and larger doses were required to achieve the same stimulation of the receptors which would produce enough endorphins to control the pain. This is called drug tolerance and is a common occurrence with certain types of drugs.


In addition to letting the cause of the pain worsen, there is a growing consensus among medical professionals that continued use of opioids like OxyContin will actually increase the pain. Pain signals are sent to the brain by a sensory receptor cell called a nociceptor. Hyperalgesia means an increased sensitivity to pain. Sometimes this is caused by damage to the nociceptors.


An increasing number of medical researchers are concluding that opioid-induced hyperalgesia is a real condition. Here are some of the studies:

  • In the November 13, 2003 New England Journal of Medicine, Dr. Ballantyne and Dr. Mao published “Opioid Therapy for Chronic Pain”. One of their conclusions was, “Long-term use of opioids may also be associated with the development of abnormal sensitivity to pain, and both preclinical and clinical studies suggest that opioid-induced abnormal pain sensitivity has much in common with the cellular mechanisms of neuropathic pain. Opioid-induced abnormal pain sensitivity has been observed in patients treated for both pain and addiction… Repeated administration of opioids not only results in the development of tolerance (a desensitization process) but also leads to a pro-nociceptive (sensitization) process… Thus, the need for dose escalation during opioid therapy – that is, the development of “apparent” opioid tolerance – may be the result of pharmacologic opioid tolerance, opioid-induced abnormal pain sensitivity, or disease progression.”
  • In “Postoperative Hyperalgesia: Its Clinical Importance and Relevance”, published in Anesthesiology:Volume 104(3) March 2006, pp 601-607, Dr. Wilder-Smith and Dr. Arendt-Nielsen point out, “We therefore have early evidence that opioids may cause hyperalgesia and that this can negatively impact early pain outcomes. However, further studies are clearly needed in this area, particularly with regard to chronic pain outcomes.”
  • In the Pain Physician, 2007 May;10:479-91, Dr. J. C. Ballantyne made four compelling points. First, there is no strong evidence supporting the long-term use of opioids for pain. Second, there is strong evidence of the opioids increasing pain. Third, the idea that it is all right to increase opioid dosages as tolerance increases is in serious doubt. Fourth, epidemiological (study of disease origin) studies are less positive, and report failure of opioids to improve QOL (quality of life) in chronic pain patients.
  • In the Journal of Pain 2006: 125: 172-179, Dr. Eriksen states, “…it is remarkable that opioid treatment of long term/chronic non-cancer pain does not seem to fulfill any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity.”
  • The February, 2008, issue of PAIN, the publication of the International Association For The Study of Pain, states, “Clinicians should consider the possibility of OIH (opioid induced hyperalgesia) when contemplating an adjustment of opioid dose when (1) previous opioid dose escalation has failed to provide the expected analgesic effect and (2) there is an inexplicable exacerbation of pain after an initial period of effective opioid analgesia. Increasing opioid dose may not always be the answer to ineffective opioid therapy, and under certain circumstances a smaller amount of opioid may lead to more effective pain reduction.”


It is not disputed that:

  • OxyContin, methadone and the other opioids prescribed for “pain” are causing thousands of overdoses and deaths;
  • Doctors have prescribed a growing number of people very high doses of opioids but the patients still find that their pain has increased;
  • Dangerously high doses of opioids can lead to an overdose and even death;
  • When someone reduces the amount of opioids in a detox, the level of pain normally reduces without any other treatments;
  • When someone reduces the amount of opioids and also has the cause of the pain addressed, they often end up drug-free and also with a much lower amount of pain." 

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