Elena Kum1,2,3, Norman Buckley2,3, Oscar de Leon-Casasola4, Mark Lema4, Jason W Busse2,5,3,6. 1. Faculty of Science, Western University, London. 2. Departments of Anesthesia. 3. Michael G. DeGroote Institute for Pain Research and Care. 4. Department of Anesthesiology, Roswell Park Cancer Institute, Buffalo, NY. 5. Health Research Methods, Evidence and Impact. 6. Canadian Veterans Chronic Pain Centre of Excellence, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVES: Opioid-induced hyperalgesia (OIH) is a phenomenon whereby opioids increase patients' pain sensitivity, complicating their use in analgesia. We explored practitioners' attitudes towards, and knowledge concerning diagnosis, risk factors, and treatment of OIH. MATERIALS AND METHODS: We administered an 18-item cross-sectional survey to 850 clinicians that managed chronic pain with opioid therapy. RESULTS: The survey response rate was 37% (318/850). Most respondents (240/318, 76%) reported they had observed patients with OIH in their practice, of which 38% (84/222) reported OIH affected >5% of their chronic pain patients. The majority (133/222, 60%) indicated that OIH could result from any dose of opioid therapy. The most commonly endorsed chronic pain conditions associated with the development of OIH were fibromyalgia (109/216, 51%) and low back pain (91/216, 42%), while 42% (91/216) indicated that no individual chronic pain condition was associated with greater risk of OIH. The most commonly endorsed opioids associated with the development of OIH were oxycodone (94/216, 44%), fentanyl (86/216, 40%), and morphine (84/216, 39%); 27% (59/216) endorsed that no specific opioid was more likely to result in OIH. Respondents commonly managed OIH by opioid dose reduction (147/216, 68%), administering a nonopioid adjuvant (133/216, 62%), or discontinuing opioids (95/216, 44%). DISCUSSION: Most clinicians agreed that OIH is a complication of opioid therapy, but were divided regarding the prevalence of OIH, etiological factors, and optimal management.
OBJECTIVES: Opioid-induced hyperalgesia (OIH) is a phenomenon whereby opioids increase patients' pain sensitivity, complicating their use in analgesia. We explored practitioners' attitudes towards, and knowledge concerning diagnosis, risk factors, and treatment of OIH. MATERIALS AND METHODS: We administered an 18-item cross-sectional survey to 850 clinicians that managed chronic pain with opioid therapy. RESULTS: The survey response rate was 37% (318/850). Most respondents (240/318, 76%) reported they had observed patients with OIH in their practice, of which 38% (84/222) reported OIH affected >5% of their chronic painpatients. The majority (133/222, 60%) indicated that OIH could result from any dose of opioid therapy. The most commonly endorsed chronic pain conditions associated with the development of OIH were fibromyalgia (109/216, 51%) and low back pain (91/216, 42%), while 42% (91/216) indicated that no individual chronic pain condition was associated with greater risk of OIH. The most commonly endorsed opioids associated with the development of OIH were oxycodone (94/216, 44%), fentanyl (86/216, 40%), and morphine (84/216, 39%); 27% (59/216) endorsed that no specific opioid was more likely to result in OIH. Respondents commonly managed OIH by opioid dose reduction (147/216, 68%), administering a nonopioid adjuvant (133/216, 62%), or discontinuing opioids (95/216, 44%). DISCUSSION: Most clinicians agreed that OIH is a complication of opioid therapy, but were divided regarding the prevalence of OIH, etiological factors, and optimal management.
Authors: Daniel Jackson; Sunita Singh; Yanli Zhang-James; Stephen Faraone; Brian Johnson Journal: Front Psychiatry Date: 2021-02-16 Impact factor: 4.157
Authors: Victor Mayoral Rojals; Moises Charaja; Oscar De Leon Casasola; Antonio Montero; Marco Antonio Narvaez Tamayo; Giustino Varrassi Journal: Cureus Date: 2022-03-10