Affiliation:
1. Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, South Korea
Abstract
Opioids have been the mainstay analgesics for postoperative, cancerous, and
chronic noncancerous pain. Common concerns regarding the use of opioids
include the development of physical dependence and addiction. However, as a
potential complication of opioid therapy, opioid-induced hyperalgesia (OIH) is often
overlooked. That is, patients receiving opioids to control their pain may paradoxically
become more sensitive to pain as a consequence of opioid therapy. OIH is a very
important issue because it may complicate the clinical course of pain treatment and
even worsen the suffering of patients receiving opioids because of the development
of excruciating pain.
Three OIH types were defined: 1) in the context of maintenance dosing and
withdrawal, 2) at very high or escalating doses, and 3) at ultra-low doses. In the
literature, most attention has been paid to the first 2 forms, and almost all cases of
reported OIH have been ascribed to morphine administration. The third form of OIH
has not been documented in humans, although it has been observed in animals.
We present 2 cases of OIH resulting from administration of tramadol, which is a
synthetic analogue of codeine and exhibits 10-fold less affinity for mu-opioid
receptors, in patients suffering from chronic pain. The 2 cases presented herein imply
the importance of recognizing OIH in patients medicated with tramadol if analgesic
effects are lost in the context of dose titration, when generalized pain is reported
without any evidence of disease exacerbation.
While OIH associated with ultra-low dose opiates seems to be quite rare, if it is
suspected, switching to other drugs and an appropriate treatment should be
considered.
Key words: Opioid-induced hyperalgesia, opioids, chronic pain, serotonin
syndrome, tramadol, ketamine
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献