Opioid-induced hyperalgesia Opioid

opioid-induced hyperalgesia – individuals using opioids relieve pain paradoxically experience more pain result of medication – has been observed in people. phenomenon, although uncommon, seen in people receiving palliative care, when dose increased rapidly. if encountered, rotation between several different opioid pain medications may decrease development of increased pain. opioid induced hyperalgesia more commonly occurs chronic use or brief high doses research suggests may occur low doses.

side effects such hyperalgesia , allodynia, accompanied worsening of neuropathic pain, may consequences of long-term treatment opioid analgesics, when increasing tolerance has resulted in loss of efficacy , consequent progressive dose escalation on time. appears largely result of actions of opioid drugs @ targets other 3 classic opioid receptors, including nociceptin receptor, sigma receptor , toll-like receptor 4, , can counteracted in animal models antagonists @ these targets such j-113,397, bd-1047 or (+)-naloxone respectively. no drugs approved counteracting opioid-induced hyperalgesia in humans , in severe cases solution may discontinue use of opioid analgesics , replace them non-opioid analgesic drugs. however, since individual sensitivity development of side effect highly dose dependent , may vary depending opioid analgesic used, many patients can avoid side effect through dose reduction of opioid drug (usually accompanied addition of supplemental non-opioid analgesic), rotating between different opioid drugs, or switching milder opioid mixed mode of action counteracts neuropathic pain, particularly tramadol or tapentadol.

nmda antagonists such ketamine
snris such milnacipran
anticonvulsants such gabapentin or pregabalin




^ wilson gr, reisfield gm (2003). morphine hyperalgesia: case report . j hosp palliat care. 20 (6): 459–61. doi:10.1177/104990910302000608. pmid 14649563. 
^ vella-brincat j, macleod ad (2007). adverse effects of opioids on central nervous systems of palliative care patients . j pain palliat care pharmacother. 21 (1): 15–25. doi:10.1080/j354v21n01_05. pmid 17430825. 
^ mercadante s, arcuri e (2005). hyperalgesia , opioid switching . j hosp palliat care. 22 (4): 291–4. doi:10.1177/104990910502200411. pmid 16082916. 
^ fine pg (2004). opioid insights:opioid-induced hyperalgesia , opioid rotation . j pain palliat care pharmacother. 18 (3): 75–9. doi:10.1080/j354v18n03_08. pmid 15364634. 
^ lee, marion; silverman, sanford m.; hansen, hans; patel, vikram b.; manchikanti, laxmaiah (2011). comprehensive review of opioid-induced hyperalgesia . pain physician. 14 (2): 151. issn 2150-1149. pmid 21412369. 
^ tompkins, d. andrew; campbell, claudia m. (2011). opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon? (pdf). current pain , headache reports. 15 (2): 129–136. doi:10.1007/s11916-010-0171-1. issn 1531-3433. pmc 3165032 . pmid 21225380. 
^ díaz jl, zamanillo d, corbera j, baeyens jm, maldonado r, pericàs ma, vela jm, torrens (september 2009). selective sigma-1 (sigma1) receptor antagonists: emerging target treatment of neuropathic pain . central nervous system agents in medicinal chemistry. 9 (3): 172–83. doi:10.2174/1871524910909030172. pmid 20021351. 
^ mitra s (2008). opioid-induced hyperalgesia: pathophysiology , clinical implications . journal of opioid management. 4 (3): 123–30. pmid 18717507. 
^ baron r (2009). neuropathic pain: clinical perspective . handbook of experimental pharmacology. handbook of experimental pharmacology. 194 (194): 3–30. doi:10.1007/978-3-540-79090-7_1. isbn 978-3-540-79089-1. pmid 19655103. 
^ candiotti ka, gitlin mc (july 2010). review of effect of opioid-related side effects on undertreatment of moderate severe chronic non-cancer pain: tapentadol, step toward solution? . current medical research , opinion. 26 (7): 1677–84. doi:10.1185/03007995.2010.483941. pmid 20465361.