Hyperalgesia and Myoclonus in Terminal Cancer Patients Treated with Continuous Intravenous Morphine

Sjosgren, P.; Jonson, T.; Jensen, Niels Rosendal; Drenck, Niels-Erik; Jensen, T. S.

doi:10.1097/00132586-199406000-00038

Cited by 28 publications

(42 citation statements)

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“…Clinically, resolving apparent clinical opioid tolerance would depend on the proper differential diagnosis between OIH, pharmacological opioid tolerance, and a worsening pain state. While opioid dose escalation may improve a worsening pain state and/or pharmacological opioid tolerance, supervised opioid tapering, opioid rotation, as well as adjunctive medications including ketamine have been shown to improve OIH [20,23,33]. Thus, recognizing characteristic QST responses may help formulate clinical plans for managing difficult cases of opioid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…(1) Patients receiving a high spinal or intravenous dose of morphine can develop the hyperalgesic response and myoclonus [1,11,12,32,33]. (2) The opioid analgesic effect decreases following a course of opioid treatment [15,20,23,36], although no changes in the opioid analgesic effect under similar clinical conditions have been reported [10].…”

Section: Introductionmentioning

confidence: 99%

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Altered quantitative sensory testing outcome in subjects with opioid therapy

Chen

Malarick

Seefeld

et al. 2009

Pain

119

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Preclinical studies have suggested that opioid exposure may induce a paradoxical decrease in the nociceptive threshold, commonly referred as opioid-induced hyperalgesia (OIH). While OIH may have implications in acute and chronic pain management, its clinical features remain unclear. Using an office-based quantitative sensory testing (QST) method, we compared pain threshold, pain tolerance, and the degree of temporal summation of the second pain in response to thermal stimulation among three groups of subjects: those with neither pain nor opioid therapy (Group 1), with chronic pain but without opioid therapy (Group 2), and with both chronic pain and opioid therapy (Group 3). We also examined the possible correlation between QST responses to thermal stimulation and opioid dose, opioid treatment duration, opioid analgesic type, pain duration, or gender in group 3 subjects. As compared with both group 1 (n = 41) and group 2 (n = 41) subjects, group 3 subjects (n = 58) displayed a decreased heat pain threshold and exacerbated temporal summation of the second pain to thermal stimulation. In contrast, there were no differences in cold or warm sensation among three groups. Among clinical factors, daily opioid dose consistently correlated with the decreased heat pain threshold and exacerbated temporal summation of the second pain in group 3 subjects. These results indicate that decreased heat pain threshold and exacerbated temporal summation of the second pain may be characteristic QST changes in subjects with opioid therapy. The data suggest that QST may be a useful tool in the clinical assessment of OIH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Altered quantitative sensory testing outcome in subjects with opioid therapy

Chen

Malarick

Seefeld

et al. 2009

Pain

119

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“…One study showed that morphine‐3‐glucuronide indirectly activates NMDA receptors, suggesting that it produces its neuro‐excitatory effects via indirect modulation of neurotransmitter release 19 . In humans, Sjogren et al 20 . has described opioid toxicity with morphine, while Thwaites et al.…”

Section: Discussionmentioning

confidence: 99%

Successful Reversal of Hyperalgesia/Myoclonus Complex with Low‐Dose Ketamine Infusion

2011

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We report the successful use of low-dose ketamine infusion for treating a severe episode of painful myoclonus in the lower extremities, associated with opioid-induced hyperalgesia (OIH), in a patient who was receiving long-term, high dose intrathecal hydromorphone therapy. A low-dose ketamine infusion immediately relieved the painful myoclonus. It also enabled a reduction in the intrathecal opioid dosage leading to a resolution of the acute symptoms attributed to OIH.

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“…The role of morphine metabolites in the pathogenesis of late opioid toxicity has been described (Table 1) [44,47,48]. Adverse effects of morphine therapy were demonstrated to be related to plasma concentrations of its metabolites [41,43,[49][50][51][52].…”

Section: Toxicitymentioning

confidence: 99%

“…Adverse effects of morphine therapy were demonstrated to be related to plasma concentrations of its metabolites [41,43,[49][50][51][52]. However, hyperalgesia may merely be the consequence of an exacerbation of preexisting pain [47]. However, hyperalgesia may merely be the consequence of an exacerbation of preexisting pain [47].…”

Section: Toxicitymentioning

confidence: 99%

Opioid rotation in cancer pain

Mercadante

1998

Current Review of Pain

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Hyperalgesia and Myoclonus in Terminal Cancer Patients Treated with Continuous Intravenous Morphine

Cited by 28 publications

References 0 publications

Altered quantitative sensory testing outcome in subjects with opioid therapy

Altered quantitative sensory testing outcome in subjects with opioid therapy

Successful Reversal of Hyperalgesia/Myoclonus Complex with Low‐Dose Ketamine Infusion

Opioid rotation in cancer pain

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