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Published on: July 29, 2014
Opioid induced hyperalgesia: clinical implications for the pain practitioner
1Comprehensive Pain Medicine, Pompano Beach, FL 33064, USA. silvpain1@bellsouth.net
Pain Physician
|May 23, 2009
Summary
Opioid-induced hyperalgesia (OIH) is a growing concern in chronic pain management. This review explores OIH
Area of Science:
- Neuroscience
- Pharmacology
- Pain Management
Background:
- Opioids are widely used for chronic pain, with evidence supporting safe use without addiction.
- Concerns regarding opioid therapy for chronic pain, especially non-cancer pain, have increased due to legal issues and abuse.
- Opioid-induced hyperalgesia (OIH) is an emerging complication of opioid therapy, distinct from tolerance.
Purpose of the Study:
- To review the neurobiological mechanisms underlying OIH.
- To summarize pre-clinical and clinical evidence supporting the existence of OIH.
- To discuss practical diagnostic and treatment considerations for OIH.
Main Methods:
- Focused review of literature on OIH.
- Examination of neurobiological mechanisms, including N-methyl-D-aspartate (NMDA) receptors, spinal dynorphins, and descending facilitation.
- Analysis of clinical studies and practical management strategies.
Main Results:
- N-methyl-D-aspartate (NMDA) receptors play a central role in OIH.
- Spinal dynorphins and descending facilitation from the rostral ventromedial medulla are also implicated in OIH.
- Differentiating OIH from worsening pain and tolerance is crucial for effective treatment.
Conclusions:
- Opioid-induced hyperalgesia (OIH) is a complex complication of opioid therapy.
- Treatment options include dose reduction, opioid rotation, NMDA receptor antagonists, and sublingual buprenorphine.
- Sublingual buprenorphine offers a simple and advantageous treatment for OIH in clinical practice.
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