Pain Killers, Endorphins, 'Diffuse' Pain

[talitha00cumi]

I've been searching for an answer to share with my doctor and hope someone here has that answer.

 

Is it possible for a long-term use of Tramadol to cause the body to stop producing its own endorphins, resulting in an area near the original pain site to react with 'diffuse' pain after relatively little physical stress?

[Glider]

Tramadol is an opioid (albeit atypical) and has effects on a number of systems in the body, including the opioid (Mu opioid) system. The basic action of any such drug occurs at synapses. Synapses have feedback systems which means that if any kind of postsynaptic receptors are activated by substances artificially introduced (i.e. by drugs), for a long period, retrograde messengers will tell the presynaptic cell to reduce production of the natural substance (transmitter).

 

In short, taking opioid painkillers (exogenous opioids) for a long enough period will reduce the levels of endogenous opioids (endorphins) produced. Subsequent sudden withdrawal of the exogenous opioids can therefore be problematic. People on long-term opioid pain medication should be weaned off.

 

So, taking tramadol long-term is likely to have an effect on endorphin production, but as to whether this would cause diffuse pain sensation near the original pain site is hard to say. If you are withdrawing from tremadol, there may be some hyperalgesia as your body adjusts and elevates endorphin production. That might explain it, but only if you have stopped taking the medication.

[talitha00cumi]

Great answser, Glider, and I appreciate it very much.

 

I went from 600-800mg Tramadol + up to 4000mg paracetamol/day to 30mg Codeine + 500mg paracetamol/day with 100mg Tramadol + 500mg paracetamol at night with no problem. In fact, after a few days, maybe a week, that diffuse pain I mentioned was gone. Just gone. After a year of debilitating diffuse pain, *poof!* gone.

 

I think it has to do with endorphin production and the way the 'keys' of Tramadol and Codeine fit the 'locks' of pain receptors. I'm guessing that switching to another pain killer allowed my own endorphin production to kick back in or perhaps for the endorphins to fit the locks abandoned by the Tramadol. Am I way off the mark?

 

Any more ideas on what might have happened would be appreciated.

[Glider]

It's very hard to say why one combination of analgesics works where another doesn't. You might not be far from the answer, but it's hard to know.

 

Codeine is quite different to tramadol. It's actually a drug precurser and is converted to morphine by liver enzymes. Codeine is going to be more specific than tramadol, which affects a number of systems (e.g. serotonin and noradrenaline), but will also work at a range of opitate receptors rather then just Mu receptors.

 

Endorphins tend to be more acute, i.e. they tend to be released at effective levels under severe, but acute situations. For example, the endorphine release that causes the 'runner's high', i.e. induced by physical exertion, only happens at around 75% VO2 max.

 

Endorphins are more effective in acute pain situations, and less so in chronic conditions, so I doubt endorphin production had much to do with your diffuse pain. I suspect it is the difference in the qualities of the new analgesic combination working on different systems and receptors.

[talitha00cumi]

Glider,

 

Once again, thank you for your thorough answer.

 

I'll be going to a pain clinic soon and will keep your info in mind when I meet with the doctors.

[Glider]

You're welcome.