From Dr. Forrest Tennant: Hyperalgesia: No Reason to Stop or Reduce Opioids

We all feel pain when pricked by a thorn. Patients with “hyperalgesia” have pain to things that do not usually hurt others. As one can imagine, this can be a very stressful way to live, to say the least.

This is a recent article by Dr. Forrest Tennant, MD, a double-American Board Certified doctor in pain and addiction medicine. He gave me permission to re-post his most supportive article for the benefit of patients with chronic pain.

Dr. Tennant puts forth a strong patient advocacy stance and seeks to educate and empower patients. Please feel free to Re-PRESS, Share & Tweet so the encouragement sinks in deep:

May 30, 2017
Forest Tennant M.D., Dr. P.H.

Please circulate to patients and families who need guidance on this subject.

One of the excuses that some health practitioners are using to stop opioids is to claim a patient has hyperalgesia (HA). This is a most dishonest, devious, and dangerous ploy.

First, the definition of hyperalgesia is simply that a stimulus such as hitting your thumb with a hammer is more painful than usual. Second, there is no way to measure or quantify the presence of HA in a chronic pain patient who takes opioids. Practitioners who claim that a chronic pain patient has HA usually do so because they don’t like the dosage that a patient must take to relieve pain or they have a bias against opioids. Some practitioners are actually telling patients that HA is harming them, and that their pain will improve or even go away if they stop opioids!! This dishonesty and deviousness may go further. Once off opioids, the practitioner may recommend that a patient have expensive, invasive or unneeded procedures. Danger may come with abrupt cessation of opioids in a severe chronic pain patient. There may be a combined or dual result of a severe pain flare along with severe opioid withdrawal symptoms. This combined effect may result in a stroke, heart attack, psychosis, or adrenal failure. Some patients may commit suicide.

All who read this need to know that many expert pain specialists either do not believe that HA even exists or that it is irrelevant to clinical practice. In other words, if a certain dosage of opioids is effective, continue treatment with opioids. There is no reason to stop or reduce opioids just based on HA.

Any time a patient is told they have HA and should stop or reduce opioids, they and their family or advocate should ask the following questions of the prescribing practitioner:

1. What test or evaluation did you do to determine that I have HA?
2. If I do have HA, what damage is it doing? (Show me some studies!!)
3. When did I get HA? (Nothing has changed in some time!)
4. I’ve heard that HA may be the result of too much neuroinflammation or hormone deficiencies? Don’t I need to be tested for these?
5. If I stop or reduce opioids and still have some pain, what are my alternatives? (Will you return me to my original opioid dosage?)

The author’s personal recommendations are: (1) If your opioids don’t seem to be as effective as they once were, get a hormone panel blood test. I’ve seen many patients boost their opioid effect by replenishing pregnenolone, testosterone, estradiol, or another hormone that has diminished.; (2) If you wish to reduce or stop your opioids, reduce your dosage about 5% a month. By slowly tapering you may be able to greatly reduce or even stop opioids.

Please inform all parties that HA is not, per se, a reason to stop or reduce opioids. More important, if you reduce or stop opioids, what is your alternative, and, if the alternative doesn’t work, what will you do?

Forest Tennant M.D., Dr. P.H.

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From Dr. Forrest Tennant: Hyperalgesia: No Reason to Stop or Reduce Opioids

10 thoughts on “From Dr. Forrest Tennant: Hyperalgesia: No Reason to Stop or Reduce Opioids

Add yours

  1. Good article,
    I reduced my opioids in 2011 and they have tried several times to reduce my pain meds but i have trouble each time, i tell them you might as well take it all away as i dont get relief with any more reduction, when i say that, they dontvwant to lose thebmonthly income and especially a legal pain person, that they need some ligit patients.


  2. I have been on high doses of opiods for 20 yrs. Of course I started off slowly with low doses but as surgeries and accidents were added onto my Fibromyalgia the pain meds went up in a pain Clinic. I never failed a pee test nor sold my medications. Now that all the agencies say that they are too high in spite of the fact I am in terrible pain the Doctors are taking us down and far too quickly. They are afraid of losing their licenses. Addicts choose to take meds to get high. If you are in true pain you do not get high. I fear that many of us may choose a bullet over the pain. I read more and more pain patients saying just that. As a Christian I know it is wrong but I too have contemplated it. If they take me any lower I will no longer be able to function. That was why I went to a pain clinic to begin with.


    1. So sorry, and I get it as s Christian, too. Fibromyalgia is a painful disease and you deserve to have a physician keep the Hippocratic oath. Pain clinic should be the right place to get pain relief. God bless you and keep you in his light.


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