Opioid-induced hyperalgesia: where are we now?

PURPOSE OF REVIEW: Patients receiving chronic opioid treatment who develop paradoxical pain sensations, as well as worsening existing pain, can be diagnosed as suffering from opioid-induced hyperalgesia (OIH). As the worldwide population expands so too does the proportion of patients who experience pain that requires a strong opioid. Recognizing the symptoms of OIH and optimizing the use of morphine in the hospital setting is imperative. This review focuses on clinical data relating to evidence of OIH at the bedside and the novel techniques employed by healthcare providers in order to improve the heightened pain sensations experienced by susceptible patients. RECENT
FINDINGS: An increasing number of randomized prospective controlled trials report worsening patient pain following high-dose opioid treatment. Patient case reports support the premise that OIH is a clinical reality. According to recent literature, for those individuals who develop paradoxical pain sensations upon chronic opioid therapy, the most successful course of action involves a multidisciplinary attack that usually comprises early diagnosis, opioid switching and adjunct therapies.
SUMMARY: Looking to the future, improved clinician-patient communication, advanced diagnostic techniques and a refinement of prescribed adjunct pharmacotherapies will offer the most successful multimodal pain management approach to the problem of OIH.