Breaking Down Hyperalgesia: Why Your Pain Feels Amplified

If everyday bumps and bruises lead to extreme pain, hyperalgesia could be the culprit. This condition amplifies pain sensitivity beyond normal levels, affecting quality of life. In this article, we will explore what hyperalgesia is, how to recognize it, the different types of hyperalgesia, and how to treat it.

What is hyperalgesia?

Hyperalgesia is considered a form of neuropathic pain¹. It's like turning up the volume on your phone, but instead of music, it's pain that gets louder. People with hyperalgesia have a lower pain threshold so they feel more pain than others. This pain doesn't just come and go; it sticks around, making things that shouldn't hurt, hurt a lot.

For someone with hyperalgesia, the pain isn't linked to any new injury or illness, but an enhance pain response. This isn't something that happens overnight. It can grow slowly and become a chronic pain syndrome.

What are the symptoms of hyperalgesia?

Hyperalgesia means feeling pain a lot more than usual, even from small things that shouldn't hurt much. The pain doesn't just pop up and then go away quickly, but stays around and can even get worse over time, spreading to other parts of the body.

People with hyperalgesia might describe what they feel as sharp or dull, like a burning feeling or a constant ache. It can happen now and then, and sometimes it can even hurt in places that weren't painful before.

Sometimes, people with hyperalgesia feel pain from things that wouldn't normally hurt at all. This is called allodynia, and it's different from what most people experience when they get hurt.

What are the types of hyperalgesia?

There are two main kinds of hyperalgesia: primary and secondary.

Primary hyperalgesia is when the actual spot of an injury becomes super sensitive. It's like the nerves there are on high alert and overreact to any pain².

Secondary hyperalgesia is when the area around an injury – not the actual injury site – hurts. It's important to know the difference between these two so doctors can figure out the best way to help with the pain².

Visceral hyperalgesia

Visceral hyperalgesia is a unique and less commonly discussed type of hyperalgesia that affects the internal organs rather than the skin or musculoskeletal system³. It can be classified as either primary or secondary hyperalgesia. One example of primary visceral hyperalgesia is irritable bowel syndrome (IBS), which can make the normal contractions and movements of the gut feel incredibly painful. An example of secondary hyperalgesia is shingles.

Referred hyperalgesia

Referred hyperalgesia is a form of secondary hyperalgesia and is a well-known condition where you feel pain in a different place than where the injury or pain source is⁴. Think of it as your body's wires getting crossed. For instance, if you're having a heart attack, you might feel pain in your arm or jaw instead of just your chest. This happens because the nerves in our bodies are all connected, and sometimes the messages they send to our brain get mixed up, making us feel pain in unexpected areas.

What is opioid-induced hyperalgesia (OIH)?

Opioid medications are sometimes prescribed for extreme pain. However, these drugs often start to lose their effectiveness after about six weeks and people need to start taking higher and higher doses to have the same effect.

In some cases, an opioid medication that is meant to alleviate pain can actually exacerbate it and a person can develop opioid-induced hyperalgesia (OIH)⁵.

If you do take opioids, it's important to only take them for a short period of time, such as immediately after an accident or surgery, and find other methods of pain management for the longer term. Always work closely with your doctor, tell them exactly how much you take and what your symptoms are so that they can keep a close eye on how you're feeling and how best to help you.

What causes hyperalgesia?

Understanding hyperalgesia can be quite complex, much like the pain it brings. It can come from different causes such as nerve injury, the way your body handles different signals and stimuli, or because of inflammation. These changes in your body can make you more sensitive to pain. So, things like surgery or taking a lot of pain medicine for a long time might lead to hyperalgesia.

Some recent studies suggest that certain immune cells, called neutrophils, might have a part in making pain worse after a nerve injury⁶.

Central sensitization

Hyperalgesia is believed to be caused by something called central sensitization⁷. Think of your central nervous system as the main character in this story of ongoing pain. What's happening is that your brain and nerves are processing signals from the body in a way that's not typical, and responding with pain.

In the case of primary hyperalgesia, the sensitivity is localized to the injury site due to an uptick in spinal neuron activity that amplifies the response to pain stimuli. Secondary hyperalgesia, on the other hand, is characterized by increased sensitivity in areas surrounding the injury, resulting from a broader range of spinal neurons becoming reactive to pain inputs.

The spinal cord is a messenger of signals. When there's a mix-up in these messages, your body might react with more pain than it should. This error can make your pain feel much worse, and it's a serious issue that needs attention.

What is the difference between hyperalgesia sensitization & fibromyalgia sensitization?

Fibromyalgia is a specific type of hyperalgesia characterized by widespread pain and profound fatigue. Fibro is also believed to originate from the alterations in the central nervous system due to central sensitization.

What is the difference between hyperalgesia & allodynia?

Hyperalgesia and allodynia are two related but distinct pain conditions. Hyperalgesia refers to an exaggerated response to painful stimuli, whereas allodynia describes a condition where normally non-painful stimuli evoke pain.

Treatment strategies for hyperalgesia: Finding relief

To manage hyperalgesia, you want to have a well-rounded treatment plan that's carefully tailored to you.

This plan might include different treatments such as medication management, physical therapy, and even psychological support. The goal is to find the right balance that addresses your symptoms and tackles the deeper issues causing your pain.

Non-opioid alternatives

There are medicines that don’t have opioids in them. NMDA receptor antagonists help make your pain feel less sharp by stopping pain receptors from being too sensitive⁸, NSAIDs help with swelling and pain, and antidepressants and anticonvulsants change the way your body sends signals.

Medication is just one component of a comprehensive pain management strategy that should include educational, lifestyle, and psychological interventions.

How to manage chronic pain caused by hyperalgesia

To handle hyperalgesia it's important to have a good plan.

Physical therapy can being many benefits through exercises and stretches that make you stronger and more flexible, which can help with the pain. Practicing mindfulness, meditation, and focusing on your breathing, can release endorphins and help you retrain your pain.

Changing your daily habits is key too. Try to sleep at the same time every night and stay away from smoking and drinking too much. These changes can help lower the chances of your pain getting worse and can improve your overall health.

To enhance your sleep quality consider the following tips:

• Strive for around eight hours of sleep each night and try to go to bed and wake up at the same time every day.
• If you feel the need to nap, keep it short. Brief naps can refresh you without affecting your sleep later on.
• Be physically active during the day. It can promote easier sleep when it's time to rest.
• Cut down on screen time before going to sleep. It helps signal to your brain that it's time to rest.
• Create a sleep-conducive environment in your bedroom. Ensure it's dark and quiet to reduce sleep interruptions.
• Watch your caffeine consumption, particularly in the afternoon and evening. Caffeine can stay in your body for hours and impact your sleep.
• Steer clear of large meals and alcohol before bed. They can disrupt your sleep quality.
• Don't forget to unwind and relax in other ways too. Doing so aids in establishing better sleep habits and managing symptoms more effectively.

Address the psychological aspects for treatment

Addressing the psychological components of your condition is a pivotal aspect of hyperalgesia management, alongside physical interventions. Cognitive behavioral therapy, often referred to as CBT, offers a transformative approach to pain perception, potentially reducing both the mental and physical strains.

A robust support system also plays a vital role for those grappling with chronic pain. It involves being encircled by people who understand what you endure daily. Pain management programs frequently include elements aimed at helping people overcome emotional hurdles, and having a network of empathetic family and friends can be instrumental in more effective pain management and improving life quality.

More information

At MoreGoodDays®, we have carefully developed an approach to help you manage your fibromyalgia. We understand how this condition can really change your day-to-day life, so we've created resources and techniques that are easy to understand and apply. These tools are designed to educate you about fibromyalgia and to equip you with ways to cope with the pain and fatigue you may experience.

We are dedicated to supporting you on your journey to a healthier and more joyful life, even with the presence of fibromyalgia.

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