Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Reznikov, Igor; Pud, Dorit; Eisenberg, Elon

doi:10.1111/j.1365-2125.2005.02418.x

Cited by 52 publications

(42 citation statements)

References 26 publications

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“…Other cross-sectional studies that compared opioid-using and opioid-naïve patients have also found no group differences in variables such as cold pain threshold and tolerance 73 , ischemic pain tolerance 39 , or pressure and thermal pain thresholds 75 . In the present set of data, we were unable to detect differences across opioid groups in pain threshold, pain tolerance, or pain ratings.…”

Section: Discussionmentioning

confidence: 91%

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

Edwards

Wasan

Michna

et al. 2011

The Journal of Pain

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This study employed quantitative sensory testing (QST) to evaluate pain responses in chronic spinal pain patients at low risk and high risk for opioid misuse, with risk classification based on scores on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Patients were further sub-grouped according to current use of prescription opioids. Of the 276 chronic pain patients tested, approximately 65% were taking opioids; a median split was used to further categorize these patients as being on lower or higher doses of opioids. The highrisk group (n= 161) reported higher levels of clinical pain, had lower pressure and thermal pain thresholds at multiple body sites, had lower heat pain tolerance, and rated repetitive mechanical stimuli as more painful relative to the low-risk group (n= 115; p’s< .01). In contrast, QST measures did not differ across opioid groups. Multiple linear regression analysis suggested that indices of pain-related distress (i.e., anxiety and catastrophizing about pain) were also predictive of hyperalgesia, particularly in patients taking opioids. Collectively, regardless of opioid status, the high-risk group was hyperalgesic relative to the low-risk group; future opioid treatment studies may benefit from the classification of opioid risk, and the examination of pain sensitivity and other factors that differentiate high- and low-risk groups.

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Section: Discussionmentioning

confidence: 91%

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

Edwards

Wasan

Michna

et al. 2011

The Journal of Pain

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“…Other confounders in a by-no-means exhaustive list include opioid-type prescribed, route of administration and modality tested; opioid addicts are proposed to have an altered sensitivity to pain that is modality dependent but not associated with allodynia [28,29]. However, as with the dosing studies, there was conflicting evidence here regarding thresholds for thermal pain between opioid-maintained and nonopioid-treated patients [30]. It is important to note that, for studies concerning the development of postoperative OIH (following a perioperative high dose of remifentanil for example), diagnostic tests are performed after the bolus of opioid has been administered.…”

Section: Key Pointsmentioning

confidence: 90%

Opioid-induced hyperalgesia

Bannister

2015

Current Opinion in Supportive &Amp; Palliative Care

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“…Except for one negative report [30], changes in pain threshold and/or pain tolerance have been observed in subjects with opioid therapy [7] or opioid addiction [9,13] using various techniques. In the present study, several methodological issues were considered.…”

Section: Discussionmentioning

confidence: 99%

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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Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

Cited by 52 publications

References 26 publications

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

Opioid-induced hyperalgesia

Altered quantitative sensory testing outcome in subjects with opioid therapy

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