Hiperalgesia asociada al tratamiento con opioides

Abstract

Opioid induced hyperalgesia is a paradoxical reaction characterized by an enhanced perception of pain related to the use of these drugs in the absence of disease progression or withdrawal syndrome. In contrast to cases of tolerance, defined as the loss of analgesic potency during prolonged use of opioids, no improvement is seen with dose escalation. Opioid induced hyperalgesia could be manifested in the context of maintenance dosing and withdrawal, at very high or escalating doses, and at ultra-low doses. To establish a differential diagnosis is important to consider that increasing the dose may produce a temporary improvement in patients with tolerance but not in those who develop hyperalgesia. Pathogenesis of this phenomenon is not well defined, but there are several experimental studies in animal models and in humans that have shown that hyperalgesia is not triggered by a single factor. Proposed mechanisms include: NMDA receptor mediation, modulation by the calcium/calmodulin protein kinase, the increase in the number of nociceptors or excitatory neurotransmitters release. There are different treatment strategies available, such as the reduction in the dose of opioid used, opioid rotation or association of other analgesic. Other options are NMDA receptor antagonists or combination therapy with COX-2 inhibitors. In this paper we review recent advances in the understanding of the underlying mechanisms, clinical studies and available treatment strategies.

Seguridad hemodinámica de la anestesia libre de opioides durante laringoscopia en una población mexicana

“…Por ejemplo, a nivel medular genera modulación de la hiperalgesia inducida por opioides, por la capacidad de los agonistas α2-adrenérgicos de regular la actividad sináptica en la médula espinal, al disminuir la actividad de los receptores NMDA (N-metil-D-aspartato), cuyos efectos son los responsables de la alodinia y la hiperalgesia, efectos indeseables del fentanilo. 6 A nivel cardiovascular, con la anestesia libre de opioides, se reduce la frecuencia cardiaca, lo cual disminuye el consumo metabólico de oxígeno, mejorando la disponibilidad de O 2 en los capilares. A nivel gastrointestinal, se disminuye la aparición de náuseas y vómito, uno de los principales efectos adversos de los opioides, por la nula estimulación de la zona de "gatillo" y la inhibición de la liberación de neurotransmisores a nivel cerebral.…”

“…Estudios recientes han informado incremento del reporte de tolerancia a sus efectos, así como hiperalgesia inducida por dichos fármacos. 5,6 Además, se ha sugerido que el uso de opioides induce una ligera inmunosupresión en pacientes con cáncer sometidos a cirugía, así como aumento en el riesgo de metástasis en dichos pacientes. 7 En adición a lo anterior, el uso ilegal y el abuso de los opioides se ha convertido en un problema de salud pública emergente.…”

Farmacología y Epidemiología de Opioides

“…The tolerance to a specific drug is a physiological response to the persistence and presence of agonists in various receptors in the CNS, most of the time as a result of the use of opioids, benzodiazepines or alcohol (Gil-Martín et al, 2014). The term tolerance indicates an adaptation to the effects of a medicine, conducting to a diminution of its effects despite the consumption of a constant dose or concentration.…”

“…Since opioids represent an inhibitory signal transduction for the cell, they increase signaling to compensate and return to the normal function. Eliminating the inhibitory signal results in an over-activation of the cellular pathways affected, driving to a variety of symptoms caused by benzodiacepinas o alcohol(Gil-Martín et al, 2014). El término tolerancia denota adaptación a los efectos de un medicamento que conduce a una disminución de sus efectos a pesar de consumir una dosis o concentración constante.…”