OIH – The Pain Medication Could be the Source of the Pain

Medicare Set-Aside Blog on October 23, 2012
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Just read an interesting article by our friends at Work Comp Roundup on Opioid-Induced Hyperalgesia (OIH). In cases where an individual is taking large quantities of opioids with no relief, there is a theory that the drug may actually be causing the pain. Nerves are excited through chemical pathways by certain types of narcotics, some with a higher propensity to cause OIH than others, such as the “phenanthrene opioid” class, which includes codeine, hydrocodone, oxycodone and hydromorphone. Apparently, Tramadol proves to provide quite effective pain relief when substituted. At about $0.80 AWP, that is far more palatable than many of the Oxycontins, particularly if they are the problem.

It is entirely possible that we have been recommending MSAs for a lifetime of drugs unnecessarily, but not for the reasons we thought. This just further proves how little physicians really know about treating pain and that the United States’ dependency on pharmacological solutions may be our biggest problem. Take a look at your book of claims to see which may show signs of OIH: characteristics include worsening pain over time despite increased dosages, pain that becomes more diffuse in and around the area of injury, sensitivity to touch around the injured area specifically, and subjective setbacks without diagnostic objective findings.

Guess the next question is once claimants are addicted to narcotics, how do we tell them that the medication that has been prescribed is the source of their pain???

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