Articles: hyperalgesia.
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To discuss the phenomenon of opioid induced hyperalgesia (OIH) and investigate the data and clinical recommendations available on this topic. ⋯ As more opioids are prescribed, especially to treat chronic nonmalignant pain, OIH becomes more of a relevant and significant issue. Although the exact mechanisms of OIH are not clearly understood further research is required to broaden and develop our knowledge of this topic.
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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. ⋯ 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.
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Opioid analgesics have become a cornerstone in the treatment of moderate to severe pain, resulting in a steady rise of opioid prescriptions. Subsequently, there has been a striking increase in the number of opioid-dependent individuals, opioid-related overdoses, and fatalities. Clinical use of opioids is further complicated by an increasingly deleterious profile of side effects beyond addiction, including tolerance and opioid-induced hyperalgesia (OIH), where OIH is defined as an increased sensitivity to already painful stimuli. ⋯ Several substrates have emerged as potential modulators of OIH, including the N-methyl-D-aspartate and γ-aminobutyric acid receptors, and most notably, the innate neuroimmune system. This review summarizes the neurobiology of OIH in the context of clinical treatment; specifically, we review evidence for several pathways that show promise for the treatment of pain going forward, as prospective adjuvants to opioid analgesics. Overall, we suggest that this paradoxical state be considered an additional target of clinical treatment for chronic pain.
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J Pain Palliat Care Pharmacother · Jun 2015
ReviewFentanyl-induced hyperalgesia in acute pain management.
There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. ⋯ The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.