Opioid-Induced Hyperalgesia

Abstract

HYPERALGESIA MEANS INCREASED sensitivity to pain. 1 Pasero C. Quinn T.E. Portenoy R.K. et al. Opioid analgesics. in: Pasero C. McCaffery M. Pain Assessment and Pharmacologic Management. Mosby/Elsevier, St. Louis, MO2011: 277-622 Google Scholar Opioid-induced hyperalgesia (OIH) is a paradoxical situation in which increasing doses of opioid result in increasing sensitivity to pain. 2 Compton P. The OIH paradox: Can opioids make pain worse? Pain treatment topics. Available at: http://pain-topics.org/pdf/Compton-OIH-Paradox.pdf. 2008. Accessed October 24, 2011. Google Scholar , 3 Chu L.F. Clark D. Angst M.S. Molecular basis and clinical implications of opioid tolerance and opioid-induced hyperalgesia. in: Sinatra R.S. de Leon-Casasola O.A. Ginsberg B. Viscusi E.R. Acute Pain Management. Cambridge University Press, Cambridge, NY2009: 114-143 Crossref Scopus (6) Google Scholar OIH has been identified as a clinical reality, but the incidence of clinically significant OIH is unknown. 3 Chu L.F. Clark D. Angst M.S. Molecular basis and clinical implications of opioid tolerance and opioid-induced hyperalgesia. in: Sinatra R.S. de Leon-Casasola O.A. Ginsberg B. Viscusi E.R. Acute Pain Management. Cambridge University Press, Cambridge, NY2009: 114-143 Crossref Scopus (6) Google Scholar , 4 Raffa R.B. Pergolizzi J.V. Opioid-induced hyperalgesia: Is it clinically relevant for the treatment of pain patients?. Pain Manag Nurs. 2012; ([in press]) PubMed Google Scholar It appears to be a relatively rare but serious consequence of opioid administration. 4 Raffa R.B. Pergolizzi J.V. Opioid-induced hyperalgesia: Is it clinically relevant for the treatment of pain patients?. Pain Manag Nurs. 2012; ([in press]) PubMed Google Scholar , 5 Chu L.F. Angst M.S. Clark D. Opioid-induced hyperalgesia in humans: Molecular mechanisms and clinical considerations. Clin J Pain. 2008; 24: 479-496 Crossref PubMed Scopus (417) Google Scholar Some researchers postulate that the incidence of OIH may be much greater, as the large number of patients with persistent noncancer pain who fail to get relief from opioids or discontinue opioid therapy because of ineffectiveness may actually have undiagnosed OIH. 2 Compton P. The OIH paradox: Can opioids make pain worse? Pain treatment topics. Available at: http://pain-topics.org/pdf/Compton-OIH-Paradox.pdf. 2008. Accessed October 24, 2011. Google Scholar Currently, it is not possible to predict who will develop OIH as a result of opioid exposure. 4 Raffa R.B. Pergolizzi J.V. Opioid-induced hyperalgesia: Is it clinically relevant for the treatment of pain patients?. Pain Manag Nurs. 2012; ([in press]) PubMed Google Scholar Chris Pasero, MS, RN-BC, FAAN, is a Pain Management Educator and Clinical Consultant, El Dorado Hills, CA Margo McCaffery, MS, RN-BC, FAAN, is a Nursing Consultant, Los Angeles, CA