Imagine that you have a slight burn on your hand while working in the kitchen. Or you have a small scratch while playing cricket. It is normal to feel a little pain at times like this. But what if that little pain becomes unbearable, so severe that you feel like screaming? That is the condition we are talking about today, `Hyperalgesia`. This is a symptom rather than a disease. Let's talk about this in a little more detail .
What is hyperalgesia simply?
Pain is actually a healthy, normal part of our bodies. It's like a warning bell. Pain tells us that something is wrong, that something is wrong with our bodies. When we feel pain, we automatically respond to it, trying to stop the pain. Imagine how many serious accidents we could be in if we didn't feel pain.
Hyperalgesia is a condition in which pain is felt at a level that is much more severe than normal, even when it should be. Simply put, the response to pain is increased. This can be caused by a variety of reasons, and can often be controlled with proper treatment.
What is the difference between Hyperalgesia and Allodynia?
Although these two words are somewhat similar, there is a clear difference between these two situations. To understand this clearly, see the table below.
| Condition | How does pain feel? | Simple example |
|---|---|---|
| Hyperalgesia | Feeling extreme, unbearable pain from something that should be painful. | Excruciating pain when touching a small burn on the hand. |
| Allodynia | Feeling pain from something that normally shouldn't cause pain. | Feeling pain even when the clothes you are wearing rub against your skin. |
Do you understand the difference? In hyperalgesia, the pain comes from something that should hurt, but it's severe. In allodynia, the pain comes from something that shouldn't hurt.
How does this thing called Hyperalgesia happen in our body?
Hyperalgesia changes the way our body generates and processes pain signals. This can happen in several main ways:
- The threshold for feeling pain is lowered: The pain threshold at which something that is normally considered uncomfortable becomes painful is greatly lowered in this condition. This means that even the smallest thing can cause pain.
- The response becomes much stronger: Our body's pain receptors become more numerous and more active than normal. This makes the pain feel much more intense.
- Pain signals don't stop: Even after the cause of the pain is removed, pain receptors become hypersensitive and continue to send pain signals to the brain.
This can be divided into two main types:
1. Primary hyperalgesia: This is when pain is felt only at the site of the injury. For example, sunburned skin feels more pain at the site of the injury.
2. Secondary hyperalgesia: This is when pain is felt in areas surrounding the injury, unrelated to the site of the injury. This occurs due to a change in the way our nervous system processes pain signals.
What are the common causes of hyperalgesia?
We now know that this condition is caused by our body's pain receptors becoming hypersensitive. There are many possible causes for this.
- Burns (including sunburn)
- Stings or bites from insects, reptiles, or other animals
- Cancer conditions
- Complications of long-term use of certain medications (we'll talk about this below)
- Nerve damage caused by diabetes (Diabetic Neuropathy)
- Immune system diseases (e.g. Lupus, Multiple Sclerosis)
- Infections affecting the nervous system (e.g. Shingles, Herpes virus)
- Conditions such as migraine
- Chronic pain disorders such as `Complex regional pain syndrome`
- Any type of external injury (such as broken bones, torn muscles, nerve injuries)
Increased pain due to painkillers (Opioid-induced hyperalgesia - OIH)
This is a very important and important point to pay attention to. When using opioid painkillers (slightly strong) for a long time, sometimes a side effect called `Opioid-induced hyperalgesia (OIH)` can occur. This means that the body's sensitivity to pain increases due to the painkillers taken to reduce pain, making the pain worse.
This is not tolerance, which is a different thing. OIH is a change in the way the body processes pain.
This is why doctors think twice about prescribing opioid painkillers long-term. If someone develops OIH, the doctor will usually gradually reduce the dose of the drug and then stop it completely. This cannot be done all at once, as it can cause dangerous side effects. Therefore, this should only be done under the advice and supervision of a doctor.
What are the treatments for hyperalgesia?
Treatment depends on the cause and type of hyperalgesia. A single treatment or a combination of treatments may be used. Only your doctor will know which treatment is best for your condition.
Here are some commonly used treatments:
- Medications: Various types of medications are used for this. For example, `Acetaminophen` (Paracetamol), `NSAIDs` (Nonsteroidal anti-inflammatory drugs), `Antidepressants`, some medications for epilepsy, and local anesthetics such as `Lidocaine`.
- Nerve ablations: This involves temporarily disabling the nerves that are sending the wrong pain signals. This can be done using radiofrequency ablation or by injecting a chemical such as Botox.
- Nerve blocks: Injecting an anesthetic drug into the nerve to stop pain signals from reaching the brain.
- TENS (Transcutaneous electrical nerve stimulation): A method of controlling pain signals by delivering a very small electrical current through the skin's surface.
What are the best times to see a doctor?
The pain from something minor, like a simple sunburn, will usually go away in a few days. However, if the pain is so severe that it's unbearable and makes it impossible to carry out your daily activities , or if the pain persists for weeks , it's definitely a sign that you should see a doctor.
It is especially important to seek medical advice for severe burns (second degree or higher), or burns to the head, face, or genitals. Your doctor will also advise you if your pain is severe enough to require a trip to the Emergency Department (ETU).
Don't forget, severe pain is a warning from our body. Ignoring it will only worsen the underlying condition or make the pain chronic.
People with this condition are not faking pain or acting out their pain. It's because there's a problem with their body's pain processing that the pain feels so intense. So if you or someone you know is experiencing this kind of unusual, severe pain, the best and safest thing to do is to seek medical advice.
Take-Home Message
- Hyperalgesia is the feeling of pain that is greater and more severe than normal when it should be felt. It is not an illusion.
- This is different from allodynia, which is when something that shouldn't be painful feels painful.
- Injuries, infections, medical conditions such as diabetes, and long-term use of some painkillers can also cause this.
- Never try to diagnose this condition yourself or treat it at home. Always see a doctor.
- Ignoring severe pain can worsen the underlying condition or cause the pain to become a chronic problem.
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