Opioid-Induced Hyperalgesia: What is the Evidence?

NATIONAL HARBOR, Md. – Approximately 250 million opioid prescriptions are written each year in the United States. This particular treatment choice has many potential side effects including dependence and addiction.1,2

There is accumulating evidence that opioid therapy might not only be associated with the development of tolerance, but also a hypersensitivity condition referred to as opioid-induced hyperalgesia (OIH) — a state of nociceptive sensitization caused by a paradoxical response upon exposure to specific or certain amounts of opioids.

Jeffrey Gudin, MD, director of pain management and palliative care at Englewood Hospital and Medical Center in New Jersey, reviewed the mechanisms of OIH, clinical examples, possible strategies to address and treat the condition and objective pain assessment measuring tools at the American Academy of Pain Management 2015 meeting. 

Opioid-induced hyperalgesia represents a distinct, definable, and characteristic phenomenon that could explain treatment failure or loss of opioid efficacy in some cases. The type of pain experienced may be same as underlying pain, but is usually different.

The condition manifests clinically as hyperesthesia (dramatically sensitivity to painful stimuli) and/or allodynia (pain elicited by a normally nonpainful stimulus), explained Dr. Gudin.