Abstract
Opioid-induced hyperalgesia (OIH) is characterized by a heightened sensitivity to pain that occurs in patients following opioid use. Prescription of opioids is currently the standard form of pain management for both neuropathic and nociceptive pain, due to the relief that patients typically report following their use. Opioids, which aim to provide analgesic effects, can paradoxically cause increasing degrees of pain among the users. The increased nociception can be either due to the underlying pain for which the opioid was initially prescribed, or other unrelated pain. As a result, those who are initially prescribed opioids for chronic pain relief may instead be left with no overall relief, and experience additional algesia. While OIH can be treated through the reduction of opioid use, antagonistic treatment can also be utilized. In an attempt to reduce OIH in patients, low doses of the opioid antagonist naltrexone can be given concurrently. This review will analyze the current role and effectiveness of the use of naltrexone in managing OIH in opioid users as described in clinical and non-clinical studies. Additionally, it seeks to characterize the underlying mechanisms that enable opioid antagonist naltrexone to reduce OIH while still allowing opioids to act as an analgesic. The authors find that OIH is a prevalent condition, and in order to effectively combat it, clinicians and patients can benefit from an extended study on how naltrexone can be utilized as a treatment alongside opioids prescribed for pain management.
Highlights
BackgroundWith over 153 million written prescriptions a year, opioids are the predominant treatment for chronic pain and postoperative pain in the United States
The authors find that Opioid-induced hyperalgesia (OIH) is a prevalent condition, and in order to effectively combat it, clinicians and patients can benefit from an extended study on how naltrexone can be utilized as a treatment alongside opioids prescribed for pain management
A very recent clinical study involving 55 human patients diagnosed with OIH and treated with low-dose naltrexone reported over a quadrupled level of pain tolerance as measured by the cold pressor test (CPT) and confirmed by statistical analysis (p
Summary
With over 153 million written prescriptions a year, opioids are the predominant treatment for chronic pain and postoperative pain in the United States. More recent studies in rats have clinically demonstrated that implantation of 30-mg naltrexone pellets significantly elevate naltrexone plasma levels and sustain pharmacologically functional levels of naltrexone such that a 50-fold rightward shift of the morphine analgesia dose-response curve is observed a full eight days later [11] These findings show great promise toward reducing the clinically recommended dosage of opioids to treat neuropathic and nociceptive pain by both minimizing the dosage of prescribed opioids and maximizing the time between dose administrations. A very recent clinical study involving 55 human patients diagnosed with OIH and treated with low-dose naltrexone reported over a quadrupled level of pain tolerance as measured by the CPT and confirmed by statistical analysis (p
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