Reduced cold pain tolerance in chronic pain patients following opioid detoxification

Jarred Younger, Peter Barelka, Ian Carroll, Kim Kaplan, Larry Chu, Ravi Prasad, Ray Gaeta, Sean Mackey

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective: One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Design: Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. Outcome Measures: We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. Results: A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. Conclusions. These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity.

Original languageEnglish (US)
Pages (from-to)1158-1163
Number of pages6
JournalPain Medicine
Issue number8
StatePublished - Dec 3 2008
Externally publishedYes


  • Chronic pain
  • Cold pressor task
  • Hyperalgesia
  • Opioids
  • Taper

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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