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J Pain Symptom Manage. 2015 Mar;49(3):632-6. doi: 10.1016/j.jpainsymman.2014.07.005. Epub 2014 Aug 13.

Opioid-induced hyperalgesia (OIH): a real clinical problem or just an experimental phenomenon?

Author information

1
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel. Electronic address: e_eisenberg@rambam.health.gov.il.
2
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.
3
Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.

Abstract

Although opioid-induced hyperalgesia (OIH) is mentioned as a potential cause of opioid dose escalation without adequate analgesia, true evidence in support of this notion is relatively limited. Most studies conducted in the context of acute and experimental pain, which seemingly demonstrated evidence for OIH, actually might have measured other phenomena such as acute opioid withdrawal or tolerance. OIH studies in patients with chronic pain have used various experimental pain models (such as cold pain tolerance or heat pain intensity). Therefore, the fact that they have yielded inconsistent results is hard to interpret. Thus far, with the exception of a few clinical case reports on OIH in patients with cancer pain and one prospective study in patients with chronic neuropathic pain, evidence for OIH in patients with chronic or cancer-related pain is lacking. Whether experimental pain models are necessary for establishing the clinical diagnosis of OIH, and which specific model is preferred, are yet to be determined.

KEYWORDS:

Experimental pain; addiction; analgesia; opioid withdrawal; tolerance

[Indexed for MEDLINE]

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