OBJECTIVES: To assess changes in phenotype and pressure sensitivity in patients with suspected opioid-induced-hyperalgesia (OIH) after transitioning to buprenorphine. METHODS: Twenty patients with suspected OIH were enrolled to transition to buprenorphine therapy. Patients completed validated self-report measures at baseline and at 1, 4, 8 weeks, and 6 months after initiation of buprenorphine along with quantitative sensory testing including measures of pressure pain threshold, pain tolerance and Pain 50 (a pain intensity rating). RESULTS: 20 patients were enrolled, 17 were treated with buprenorphine and 11 completed all assessment points. We found that after transitioning to buprenorphine, patients on higher opioid doses (≥100mg oral morphine equivalents) had significant improvements for some measures including decreased pain severity and fibromyalgia survey scores, fewer neuropathic pain features, less catastrophizing, fewer depressive symptoms, and improved functioning 1-week after transitioning to buprenorphine with an eventual return back to baseline. Although not statistically significant, patients on high dose opioids (≥100mg OME) also showed a trend of decreased pressure sensitivity 1-week after transitioning to buprenorphine with a gradual return back to baseline. CONCLUSIONS: Our study is the first to look at pressure pain sensitivity in patients who were taking opioids and transitioned to buprenorphine. These results suggest that the patients most likely to benefit from buprenorphine therapy are those on higher doses. In addition, the eventual return back to baseline on measures of pain phenotype and pressure sensitivity suggests that buprenorphine may over time result in a return of the hyperalgesic effects of a full mu agonist.
OBJECTIVES: To assess changes in phenotype and pressure sensitivity in patients with suspected opioid-induced-hyperalgesia (OIH) after transitioning to buprenorphine. METHODS: Twenty patients with suspected OIH were enrolled to transition to buprenorphine therapy. Patients completed validated self-report measures at baseline and at 1, 4, 8 weeks, and 6 months after initiation of buprenorphine along with quantitative sensory testing including measures of pressure pain threshold, pain tolerance and Pain 50 (a pain intensity rating). RESULTS: 20 patients were enrolled, 17 were treated with buprenorphine and 11 completed all assessment points. We found that after transitioning to buprenorphine, patients on higher opioid doses (≥100mg oral morphine equivalents) had significant improvements for some measures including decreased pain severity and fibromyalgia survey scores, fewer neuropathic pain features, less catastrophizing, fewer depressive symptoms, and improved functioning 1-week after transitioning to buprenorphine with an eventual return back to baseline. Although not statistically significant, patients on high dose opioids (≥100mg OME) also showed a trend of decreased pressure sensitivity 1-week after transitioning to buprenorphine with a gradual return back to baseline. CONCLUSIONS: Our study is the first to look at pressure pain sensitivity in patients who were taking opioids and transitioned to buprenorphine. These results suggest that the patients most likely to benefit from buprenorphine therapy are those on higher doses. In addition, the eventual return back to baseline on measures of pain phenotype and pressure sensitivity suggests that buprenorphine may over time result in a return of the hyperalgesic effects of a full mu agonist.
Authors: Frederick Wolfe; Daniel J Clauw; Mary-Ann Fitzcharles; Don L Goldenberg; Winfried Häuser; Robert S Katz; Philip Mease; Anthony S Russell; I Jon Russell; John B Winfield Journal: J Rheumatol Date: 2011-02-01 Impact factor: 4.666
Authors: Laxmaiah Manchikanti; Salahadin Abdi; Sairam Atluri; Carl C Balog; Ramsin M Benyamin; Mark V Boswell; Keith R Brown; Brian M Bruel; David A Bryce; Patricia A Burks; Allen W Burton; Aaron K Calodney; David L Caraway; Kimberly A Cash; Paul J Christo; Kim S Damron; Sukdeb Datta; Timothy R Deer; Sudhir Diwan; Ike Eriator; Frank J E Falco; Bert Fellows; Stephanie Geffert; Christopher G Gharibo; Scott E Glaser; Jay S Grider; Haroon Hameed; Mariam Hameed; Hans Hansen; Michael E Harned; Salim M Hayek; Standiford Helm; Joshua A Hirsch; Jeffrey W Janata; Alan D Kaye; Adam M Kaye; David S Kloth; Dhanalakshmi Koyyalagunta; Marion Lee; Yogesh Malla; Kavita N Manchikanti; Carla D McManus; Vidyasagar Pampati; Allan T Parr; Ramarao Pasupuleti; Vikram B Patel; Nalini Sehgal; Sanford M Silverman; Vijay Singh; Howard S Smith; Lee T Snook; Daneshvari R Solanki; Deborah H Tracy; Ricardo Vallejo; Bradley W Wargo Journal: Pain Physician Date: 2012-07 Impact factor: 4.965
Authors: Steven E Harte; Mainak Mitra; Eric A Ichesco; Megan E Halvorson; Daniel J Clauw; Albert J Shih; Grant H Kruger Journal: Med Biol Eng Comput Date: 2013-02-05 Impact factor: 2.602
Authors: Allison M Janda; Sawsan As-Sanie; Baskar Rajala; Alex Tsodikov; Stephanie E Moser; Daniel J Clauw; Chad M Brummett Journal: Anesthesiology Date: 2015-05 Impact factor: 7.892