Opioid-induced hyperalgesia
| Opioid-induced hyperalgesia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Opioid-induced hyperalgesia[1] or opioid-induced abnormal pain sensitivity[2] is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli. Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.[3]
Pathophysiology
The need for dose escalation in opioid therapy may be as a result of tolerance, as a result of opioid-induced hyperalgesia, or, more likely, a combination of both. Thus patients receiving medications to relieve pain may paradoxically have more pain as a result of their medication.
This phenomenon likely results from changes in NMDA receptors in the dorsal horn of the spinal cord. Research on the mechanisms underlying this phenomenon is ongoing, as are attempts to identify NMDA receptor antagonists, which may be able to prevent or attenuate this effect.
Treatment
If an individual is taking opioids for a chronic non-cancer pain condition, and requires increasing doses, yet still do not achieve pain relief, they may be experiencing opioid-induced hyperalgesia. If so, they may benefit from complete withdrawal from opioid therapy. Many individuals report reduced pain levels when opioids are withdrawn.[4]
References
- ↑ Angst, MS & Clark, DJ: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology 2006; 104:570–87
- ↑ Mao J: Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain 2002; 100:213–7
- ↑ Celerier E, Laulin J-P, Corcuff J-B, Le Moal M, Simonnet G: Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process. J Neurosci 2001; 21:4074–80
- ↑ Wuitchik, M. & Feehan, GG: Opioid withdrawal versus opioid maintenance for persons with chronic non-cancer pain: The experience of the Canmore Pain Clinic. Rehab Review 2006; 2:19-21
Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs