POTD: Opioid Induced Hyperalgesia

OPIOID INDUCED HYPERALGESIA

WHAT IS IT?

▪ Opioid induced hyperalgesia is pain sensitization paradoxically caused by chronic exposure to opioids.
▪ The patient becomes more sensitive to certain painful stimuli and sometimes experiences pain from otherwise non-painful stimuli (allodynia)

HOW DO I IDENTIFY IT?

▪ Opioids aren’t working anymore for pain that used to be alleviated with the opioid (analgesic tolerance)
▪ Confusion, worsening of pain, or more widespread pain with tremulousness, even with increasing doses of opioids
▪ Can be a confounding factor in states of delirium

HOW DO I TREAT IT?

▪ No well-established treatment, but Dr. Motov has successfully treated selected patients with a ketamine bolus followed by a ketamine drip.

Resource: UptoDate, Prevention and management of side effects in patients receiving opioids for chronic pain