Opioid-induced hyperalgesia from alfentanil.

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Medicine

Background:

• Opioid-induced hyperalgesia (OIH) is a poorly understood phenomenon.
• Existing literature primarily focuses on phenanthrene opioids like fentanyl and remifentanil.

Observation:

• A patient experienced suspected OIH attributed to alfentanil, a less commonly implicated opioid.
• The patient's underlying dementia increased susceptibility to OIH.

Findings:

• Reducing the alfentanil dose resulted in a significant decrease in the patient's pain.
• OIH was identified as a critical differential diagnosis for escalating pain when other causes were excluded.

Implications:

• This case highlights alfentanil as a potential cause of OIH.
• Clinical expertise is vital for diagnosing and managing OIH, especially in vulnerable patients.
• OIH should be considered in cases of unexplained pain escalation during opioid therapy.