Dear Jannelle -

Whike I agree with everyone else that there is no evidence linking narcotics to RSD spread, you should be aware that there is plenty of evidence to support the proposition that too much opioid consumption may result in a condition called hyperalgesia, which "has been recognized as a potential form of central sensitization in which a patient's pain level increases in parallel with elevation of his or her opioid dose." See, Significant pain reduction in chronic pain patients after detoxification from high-dose opioids, Baron MJ, McDonald PW, J Opioid Manag. 2006 Sep-Oct;2(5):277-82, free full text at http://www.rsds.org/2/library/articl...n_McDonald.pdf, the abstract of which follows:

Opioid tolerance is a well-established phenomenon that often occurs in patients taking opioids for the treatment of chronic pain. Typically, doctors need to periodically elevate patients' opioid doses in an attempt to manage their underlying pain conditions, resulting in escalating opioid levels with only moderate to negligible improvement in pain relief. Recently, opioid-induced hyperalgesia has been recognized as a potential form of central sensitization in which a patient's pain level increases in parallel with elevation of his or her opioid dose. Here, we report a retrospective study of patients undergoing detoxification from high-dose opioids prescribed to treat an underlying chronic pain condition which had not resolved in the year prior. All patients were converted to ibuprofen to manage pain, with a subgroup treated with buprenorphine during detoxification. Self-reports for pain scores were taken at first evaluation, follow-up visits, and termination. Twenty-one of 23 patients reported a significant decrease in pain after detoxification, suggesting that high-dose opioids may contribute to pain sensitization via opioid-induced hyperalgesia, decreasing patient pain threshold and potentially masking resolution of the preexisting pain condition.

PMID: 17319259 [PubMed - indexed for MEDLINE]

That maybe what they were referring to. But the question becomes whether your narcotic use is high enough to tigger even hyperalgesia in the first place? (And keeping in mind that if your therapists have any connection with the University of Washington, they will definitely be of the "grin and bear it school of thought.)

Ind fact, instead of complete withdrawl form opioids, the more enlightened view seems to be that of opioid rotation, where when a level of a narcotic (Oxycontin, Morphine, Fentanyl, etc.) is no longer working, instead of increasing the dose and inviting more problems, you're just switch out the one narcotic to another, without increasing the overall amount of opiods you're on. See, e.g., Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec) in chronic pain patients, Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV, Pain Pract. 2007 Jun;7(2):123-9. Heinrich-Heine-University Clinics, Moorenstrasse, Düsseldorf, Germany. enno.freye@uni-duesseldorf.de

And here's the abstract:

Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine.

PMID: 17559481 [PubMed - indexed for MEDLINE]

I hope this is helpful. And good luck!

Mike