Popular Painkillers That Can Cause Killer Pain

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Penny S. seemed to have it all. She was young, pretty and active. Her husband was successful; her children healthy and happy. Then, out of nowhere, the pain began. It started as an aching fatigue in the afternoons and evenings. At night, “she looked like she’d hit a brick wall’” says her husband, Kent. “I…hurt…all…over,” is all Penny says, pausing between each drawn-out word for effect.

A doctor eventually diagnosed fibromyalgia—a syndrome that triggers pain throughout the body—and prescribed Vicodin, the top-selling opioid painkiller. “I liked the feeling of it, and it worked great,” Penny recalls. The Vicodin was a godsend: It enabled her to keep up with her responsibilities—kids, housework, social life—while continuing to work. Some days were better than others, of course, but the painkiller kept her head above water and she even started down the road to recovery from alcoholism.

Shawn F. is an addict of a very different stripe. At five-nine and 120 pounds, he’s a little guy, but he’s survived more than his share of addiction-induced mayhem, including motorcycle and car wrecks, bar fights and gunshots. “I kept a .45 in a shoulder holster, a 9mm in my belt and a derringer in my boot,” Shawn recalls. “I was a danger to the public. My drug was more.” Finally, Shawn’s multiple narcotics addictions landed him in a ward for the chemically psychotic. “I got sober strapped to a table,” Shawn says.

Shawn’s case is the kind that makes doctors cringe. His physician, Dr. Jonathan Tallman, says, “His body is a mess—arthritis everywhere, multiple failed back and neck surgeries.” Pain management requires a daily choice between lifelong suffering and life-threatening addiction.

One of the dangers of narcotics prescribed for chronic pain management is that they can reawaken the addict slumbering in the sober soul. Alert to this hazard, Shawn long ago worked out a regimen with his wife, older brother and sponsor. “They have a key to my med box. My wife checks it every couple of days,” he says. “I do not take drugs recreationally.”

Shawn had no way of knowing that he was about to be ambushed by a very different medical condition. One day, with virtually no warning, his pain meds stopped working—and the explosion of raw agony throughout his body and brain far exceeded what he recalled as his baseline level of pain. “When I stubbed my toe, it felt like someone slammed it with a hammer,” says Shawn, still shaken by the recollection.

At first he thought the problem was “all in his head” and he could “tough it out.” But after several days, when the pain had not diminished, he went to his doctor. The diagnosis—opioid-induced hyperalgesia— was so bizarre it might have been lifted from the plot of a horror movie. The painkillers had not merely lost their effect; they had triggered a syndrome of hypersensitivity to pain, even to stimuli that previously had not registered as painful.

Opiate-induced hyperalgesia is what doctors call a "paradoxical phenomenon,” a drug having the reverse effect than intended. After decades of heroin abuse topped off by a medical course of OxyContin and other prescription opiates for pain, the accumulated damage caused certain receptors in Shawn’s central nervous system leading to certain pathways in his brain to hit critical mass. His pain wiring went haywire.

The condition is actually not uncommon (albeit blessedly temporary) in non-addicts even on short-term high-dose prescription opiates. “Any individual can develop hyperalgesia after 30 days and maybe 75 to 100 morphine units a day,” says Dr. Michael Hooten, director of the Pain Rehabilitation Center at Mayo Clinic. But for addicts, the condition tends to be not only more prevalent but more acute, complex and long-lasting. According to Hooten, 20 to 30 percent of the general population struggles with chronic pain, but among addicts the proportion is 45 percent or more.