Pressure Pain Sensitivity in Patients With Suspected Opioid-Induced Hyperalgesia

Abstract

Background and Objectives This study was designed to test whether a brief quantitative sensory testing (QST) assessment could be used to detect hyperalgesia in patients with suspected opioid-induced hyperalgesia. Methods Twenty patients on long-term opioid therapy with suspected opioid-induced hyperalgesia were recruited along with and 20 healthy controls. Pressure pain threshold, Pain50, a measure of intermediate suprathreshold pressure pain sensitivity, and tolerance levels, were evaluated. As a secondary outcome, changes in pressure pain sensitivity following intravenous administration of placebo (saline) and fentanyl (1.5 μg/kg) were assessed. Results There were no significant differences in pain measures between healthy controls and patients. However, there was an association between higher doses of opioids and having a lower pain tolerance (r= -0.46, P=0.041) and lower Pain50 (r=-0.46, P = 0.044), which was consistent with the hypothesis. Patients on >100 mg oral morphine equivalents (OME) displayed decreased pressure pain tolerance compared to patients taking <100 mg OME (P = 0.042). In addition, male patients showed a hyperalgesic response to fentanyl administration, which was significant for the Pain50 measure (P=0.002). Conclusions Whereas there were no differences between patients suspected of having opioid-induced hyperalgesia and the healthy controls, the finding that higher doses of opioids were associated with more sensitivity suggests that dose might be an important factor in the development of hyperalgesia. In addition, male patients demonstrated a hyperalgesic response after a bolus of fentanyl. Future studies are needed to develop better diagnostics for detecting hyperalgesia in the clinical setting.

Endogenous opioidergic dysregulation of pain in fibromyalgia: a PET and fMRI study

“…45 While this mechanism is considerably less well characterized in humans, OIH has been demonstrated by reductions in experimental pain thresholds in drug addicts taking methadone, patients receiving high doses of exogenous opioids during surgery, and community dwelling adults with chronic pain using opioids long term. 2; 33; 63 While short-term use of opioids may not exacerbate experimental pain in human chronic pain patients, 12 long-term exposure, particularly at higher doses, may well have different and more deleterious effects. 9; 63 It is therefore possible that the relationship between low MOR BP and reduced anti-nociceptive brain responses to pain is an endogenous process analogous to OIH.…”

“…2; 33; 63 While short-term use of opioids may not exacerbate experimental pain in human chronic pain patients, 12 long-term exposure, particularly at higher doses, may well have different and more deleterious effects. 9; 63 It is therefore possible that the relationship between low MOR BP and reduced anti-nociceptive brain responses to pain is an endogenous process analogous to OIH. This may help explain why recent prospective long-term studies of opioid use in FM do not generally support their efficacy.…”

“…This knowledge deficit is particularly striking considering the continued use of opioids in the treatment of FM, despite poor evidence supporting opioid efficacy in this condition and good evidence showing that long-term opioid administration can lead to opioid-induced hyperalgesia (OIH). 3; 63 …”

Somatic Awareness and Tender Points in a Community Sample

“…20 Various medications can also modulate pain responses. For instance, long-term use of opioids is suspected of promoting hyperalgesia in some patients, 67 antidepressants may be effective in pain relief for some conditions but not others 57, 63 and the chronic use of benzodiazepines is associated with chronic pain, though the association is not yet well understood. 40, 51 In these analyses the use of opioids, sedatives and antidepressants were all associated with a greater number of tender points, perhaps indicating neural modulation of pain or psychopathology, though determining the nature of the association is not possible in a cross-sectional study.…”

Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care

“…However, short-acting opioids may paradoxically worsen the problem because of their association with hyperalgesia. 2,3 It would seem that hyperalgesia from using short-acting opioids, such as fentanyl, during routine GA in a blocked patient would undermine the value of the block.…”