Opioid-induced hyperalgesia

Opioid-induced hyperalgesia (OIH) or opioid-induced abnormal pain sensitivity, also called paradoxical hyperalgesia, is an uncommon condition of generalized pain caused by the long-term use of high dosages of opioids[1] such as morphine,[2] oxycodone,[3] and methadone.[4][5] OIH is not necessarily confined to the original affected site.[6] This means that if the person was originally taking opioids due to lower back pain, when OIH appears, the person may experience pain in the entire body, instead of just in the lower back. Over time, individuals taking opioids can also develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia).[6] This means that if the person originally felt pain from twisting or from sitting too long, the person might now additionally experience pain from a light touch or from raindrops falling on the skin.

OIH differs from drug tolerance, although it can be difficult to tell the two conditions apart. OIH can often be treated by gradually tapering the opioid dose and replacing opioid-based pain care with other pain management medications and techniques or by opioid rotation.[7]

  1. ^ Higgins, C.; Smith, B. H.; Matthews, K. (June 2019). "Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis". British Journal of Anaesthesia. 122 (6): e114–e126. doi:10.1016/j.bja.2018.09.019. ISSN 1471-6771. PMID 30915985.
  2. ^ Julie L. Cunningham (2013) Opioid induced hyperalgesia: A focus on opioid use in chronic pain. Mental Health Clinician: June 2013, Vol. 2, No. 12, pp. 395–397.
  3. ^ BNM Group. 2014. Oxycodone (BNM) Data Sheet. 13 March 2014. URL: www.medsafe.govt.nz/profs/Datasheet/o/oxydoneBNMtab.pdf (accessed 22 July 2015).
  4. ^ Compton P, Charuvastra VC, Ling W (July 2001). "Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent". Drug and Alcohol Dependence. 63 (2): 139–46. doi:10.1016/s0376-8716(00)00200-3. PMID 11376918.
  5. ^ Compton P, Charuvastra VC, Kintaudi K, Ling W (October 2000). "Pain responses in methadone-maintained opioid abusers". Journal of Pain and Symptom Management. 20 (4): 237–45. doi:10.1016/s0885-3924(00)00191-3. PMID 11027904.
  6. ^ a b Cite error: The named reference Yi 2015 was invoked but never defined (see the help page).
  7. ^ Fishbain, David A.; Pulikal, Aditya (1 November 2019). "Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review". Pain Medicine (Malden, Mass.). 20 (11): 2179–2197. doi:10.1093/pm/pny231. ISSN 1526-4637. PMID 30597076.