Use, Abuse, and Addiction
Pain in Opioid Withdrawal and Protracted Abstinence
Increased sensitivity to pain has been observed in individuals with opioid addiction during abstinence. Individuals with former opioid addiction either maintained on methadone or maintained on the partial agonist buprenorphine showed increased sensitivity to cold pressor pain. Such a hyperalgesic-like state can persist for up to 5 months in abstinent individuals with a history of opioid addiction. Individuals with addiction and heightened pain sensitivity also displayed greater cue-induced craving at this time point, and pain is one of the main triggers of relapse to addiction in methadone-maintained individuals. Thus, opioid-addicted individuals with poor pain tolerance may suffer a more severe form of addiction, have difficulty tolerating the discomfort (pain) inherent in detoxification and early abstinence, and be more likely to relapse.