ArticlePain2016
Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon.
Article in Pain, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography.BMJ open · 2020Pooled it
- Transcranial Direct Current Stimulation to Improve the Dysfunction of Descending Pain Modulatory System Related to Opioids in Chronic Non-cancer Pain: An Integrative Review of Neurobiology and Meta-Analysis.Frontiers in neuroscience · 2019Pooled it
- Central amygdalar PKCδ neurons mediate fentanyl withdrawal.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026Article
- Article
- Timing impact of single shot femoral nerve block on rebound pain in patients undergoing total knee arthroplasty: a prospective randomized controlled trial.Frontiers in medicine · 2026Article
- Opioid prescribing in Canada: a continued retreat from God's own medicine.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025Article
- Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series.Canadian journal of pain = Revue canadienne de la douleur · 2024Article
- Validation and endorsement of health system performance measures for opioid use disorder in British Columbia, Canada: A Delphi panel study.Drug and alcohol dependence reports · 2022Article
- Withdrawal-associated injury site pain prevalence and correlates among opioid-using people who inject drugs in Vancouver, Canada.Drug and alcohol dependence · 2020Article
- Oxycodone self-administration and withdrawal behaviors in male and female Wistar rats.Psychopharmacology · 2020Article
- Canadian Guidelines on Opioid Use Disorder Among Older Adults.Canadian geriatrics journal : CGJ · 2020Article
- Opioid-Induced Tolerance and Hyperalgesia.CNS drugs · 2019Review
- Linking opioid-induced hyperalgesia and withdrawal-associated injury site pain: a case report.Pain reports · 2018Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation-a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation.
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Registered trials
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