The chief symptom of hyperalgesia is increased pain sensitivity (without new injury, damage to an existing injury, or worsening of a medical condition). It is difficult to completely eliminate hyperesthesias and other neuropathic pain symptoms. This should be explained to the patient early during the treatment course. Monotherapy should be initially started; however, 45% of the patients with neuropathic pain are on two or more medications for their pain. Chronic pain also has potential long-term effects that can seriously affect your quality of life.

• When you have hyperpathia, you may find that you identify and/or locate the painful stimulus erroneously, or there may be a delay between when you come into contact with the stimulus and when you experience it.
• However, future research into quantitative sensory testing methods coupled with a consensus definition of OIH, could improve screening and prevention.
• In particular, the usage of open-ended questions for the development of individualized tapering plans is recommended.
• Allodynia and hyperalgesia are often a component of a neuropathic pain syndrome.
• They also connect to other symptoms like allodynia, which is when things that shouldn’t hurt cause pain, like brushing your hair or putting on clothes.

That’s called “sensitization,” and it usually involves pain signaling. When this happens, the nervous system cells that handle pain signals become too responsive to pain signals. Pain signals can become more intense, easier to trigger or may happen without a reason. Hyperesthesia may indicate that your nervous system isn’t working properly.

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How does visceral sensitivity affect my body?

Thus, in addition to decreased analgesia, opioid tolerance may also decrease opioid side effects including nausea, respiratory depression and sedation 44. Thus opioid cessation results in increased NE levels and elicits the symptoms of opioid ‘withdrawal’ including muscle spasms, abdominal cramps, anxiety, palpitations and hot flashes 45. Withdrawal symptoms for short-acting opioids (e.g., heroin, oxycodone and hydrocodone) typically occur within 12 h of cessation, peak at 36–72 h and taper over 4–7 days 46. This timeline highlights another critical difference between tolerance/withdrawal and OIH, as OIH potentially has much longer-lasting effects. Opioid-induced hyperalgesia (OIH) occurs when opioid medications worsen rather than decrease pain. Although mechanisms of OIH are thought to primarily start in the brain or brainstem before traveling through the spinal cord to the area of pain in the body, there are likely many causes.

Deterrence and Patient Education

Complications of hyperesthesia include increased morbidity if symptoms are not controlled. The patient may also experience increased morbidity from extensive interventional procedures. Also, if the patient is started on potent opioids for treatment, the patient may become addicted. Opioid-induced hyperalgesia (OIH) happens when taking opioids for a long time makes you more sensitive to pain instead of relieving it. It can become tough to tell the difference between pain from withdrawal and pain from hyperalgesia. But at Briarwood Detox Center in Austin, TX, we offer detox programs that help you manage both issues with care and attention.

Notably, the primary literature highlights that the same pathways involved in OIH are also involved in opioid tolerance, opioid-induced analgesia and chronic pain. Thus, while differentiating these diseases is essential, processes that improve descending modulation or produce analgesia without using opioids are most beneficial, regardless of the diagnosis. Notably, interventions do not need to be pharmacologic, as exercise has been shown to aid in preventing OIH in animals via a descending modulatory-mediated mechanism 33. Alternatively, non-opioid analgesics can assist with opioid dose reduction and may play a role in OIH prevention.

How is visceral hypersensitivity diagnosed?

It won’t hurt or feel like it’s burning you, but the feeling of warmth will be very difficult — if not impossible — to ignore or tune out. Hyperesthesia is a malfunctioning of your sense of touch, making sensations more intense than expected. It doesn’t necessarily involve pain, but the sensations can become overwhelming or distracting.

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As the central glutaminergic system and NMDA receptor activation are thought to be important drivers of OIH, ketamine and methadone are often prescribed to prevent and treat OIH 67,68. In diabetic mice, ketamine reversed remifentanil induced hyperalgesia and allodynia 69. Clinically, patients randomized to intravenous perioperative ketamine demonstrated reduced opioid consumption67 and a reduced incidence of chronic post surgical pain (CPSP) 70. However, acetaminophen has also been shown to block substance P 71,72 and NMDA 71, in animal models, resulting in the prevention of hyperalgesia. Although NSAIDs also reduce prostaglandin release, decreasing nociceptive signaling 73 and opioid consumption 74,75, it is not certain that NSAIDs reduce OIH.

If you’re experiencing an episode of hyperesthesia, lie down in a dark room that’s as free from stimuli as possible. However, the review largely used studies that tested the effects of flavonoids in a lab and on animals, rather than in humans. The review also focused only on peripheral neuropathy, but other types like central neuropathy might work differently. A 2020 review suggests a diet with plenty of flavonoids might help people reduce the effects of neuropathy. Flavonoids are compounds in plants that provide antioxidants, which help counter the harmful effects of damaging free radical molecules around your body.

What are the most common causes of hyperesthesia?

In other words, hyperalgesia: causes, symptoms, treatment, and more with hyperpathia, your reaction to a stimulus, especially a repeating one, is increased. Such stimuli include touch, vibration, pinpricks, heat, cold, and pressure. Hyperesthesia and hyperalgesia both connect to neuropathic pain and other pain syndromes. They also connect to other symptoms like allodynia, which is when things that shouldn’t hurt cause pain, like brushing your hair or putting on clothes.

• These symptoms significantly impact daily life, making simple activities like brushing hair, hugging, or resting on a chair uncomfortable or even unbearable.
• For example, α-2-receptor agonists may be more efficacious in reversing hyperalgesia when used in combination with ketamine, rather than as a sole agent 68.
• They do not have any specialized sense organs and rely on skin receptors to gather sensory information.
• Although pre-operative screening for chronic post surgical pain risk has rarely been effectively applied, quantitative sensory testing is predictive in small studies 120.

Analgesic strategies can include passive range or motion, moist heat or ice therapy. Further, relaxation, behavioral instruction and other psychological support strategies may have utility for analgesia and should be considered to prevent OIH 105–107. In the pre-operative period, opioid education, chronic opioid cessation or tapering and risk assessment are imperative (Figure 2).

Treatment involves treating underlying conditions and symptomatic support. A multidisciplinary approach that is able to provide timely diagnosis and treatment has the best outcomes. This activity outlines the evaluation and management of hyperesthesia and reviews the role of the interprofessional team in evaluating and treating patients with this condition. Hyperesthesia commonly happens along with neuropathic pain and other pain- or nerve-related conditions.