Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

Colvin, Lesley; Bull, Fiona; Hales, Tim G.

doi:10.1016/s0140-6736(19)30430-1

Cited by 359 publications

(331 citation statements)

References 119 publications

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confidence: 99%

“…To that end, recent literature suggests that hyperalgesia may be linked to the development of opioid tolerance . Hyperalgesia is particularly problematic as further opioid prescribing is largely futile , and when combined with opioid tolerance both contribute to poorly controlled pain and dose escalation . Opioid‐induced allodynia—a condition when a normally benign stimulus is perceived as pain—may further dampen the efficacy of opioid pharmacotherapy for chronic pain management, as it may dampen the perceived benefits of treatment from the patient's perspective .…”

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confidence: 99%

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Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Bahji

2020

Addiction

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confidence: 99%

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confidence: 99%

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Bahji

2020

Addiction

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“…14,15 Time between surgery and delivery captures more women with opioid expos ures at younger ages who may have multiple surgeries, or more time to develop opioid tolerance and hyperalgesia requiring higher opioid doses. 16 We used the surgical specialty to classify interventions, including general surgery, cardiovascular or thoracic surgery, neurosurgery, orthopedic, urologic, obstetric or gynecologic, plastic or dermatologic surgery, ophthalmology, otorhinolaryn gology, oral and maxillofacial or dental, and other surgery. We did so because complex and invasive surgeries may require more opioids for pain control.…”

Section: Exposurementioning

confidence: 99%

Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study

Auger

Low

Carrier

et al. 2019

CMAJ

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T he opioid epidemic has led to an alarming increase in the number of infants with neonatal abstinence syndrome in the United States and Canada. 1-3 Between 2009 and 2013, the incidence of neonatal abstinence syndrome doubled from 3.6 to 7.3 per 1000 births in the US alone. 2 Neonatal absti nence syndrome is a withdrawal syndrome caused by sudden interruption of intrauterine drug exposure at birth and occurs in 55%-94% of infants exposed to opioids prenatally. 4-6 Symptoms include fever, respiratory complications, weight loss and sei zures, and affected infants frequently require admission to the intensive care unit. 4-6 Complications are not limited to the neo natal period, and include injury, infection, mental and behav ioural disorders and ophthalmologic disorders. 7,8 Many of these complications could be avoided by preventing intrauterine exposure to opioids, which is challenging as the factors leading to chronic opioid use in women have not been fully elucidated. Many women are first introduced to opioids after surgery through prescriptions for postoperative pain control, 9-12 but the potential link with neonatal abstinence syndrome in future pregnancies has never been assessed. Opioids are commonly prescribed for postsurgical pain 9-12 and predispose young sur gical patients to prolonged opioid use. 11 Nearly 5% of young opioid naive patients continue to use opioids several months after sur gery. 11 Owing to the high frequency of surgical procedures at young ages, 11 women who undergo surgery may be more vulner able to prolonged opioid use during their reproductive years. The possibility that opioid use after surgery can be substantial enough to persist in future pregnancies has not been considered. We sought to determine the association of maternal pre pregnancy surgery with the subsequent risk of neonatal absti nence syndrome in infants. Methods Study design and population We performed a retrospective cohort study of 2 182 365 births between 1989 and 2016 in Quebec, Canada. We used hospital data compiled in the Maintenance and Use of Data for the Study RESEARCH

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“…Both morphine's analgesia and its side-effects (tolerance, respiratory depression, 75 euphoria, and dependence) are mediated by MOR. Clinical studies provide strong 76 evidence that, although opioids are excellent analgesics for acute pain such as post-77 operative pain, long-term use of opioids is not associated with useful pain relief in 78 most people (Colvin et al, 2019). This loss of analgesic benefit is attributed to MOR 79 tolerance and the manifestation of opioid-induced hyperalgesia (Yang et al, 2019), 80 both of which have major implications for pain trajectories per se, as well as post-81 operative outcomes and a contribution towards poorly-controlled pain (Colvin et al, 82 2019).…”

Section: Introduction (628) 68mentioning

confidence: 99%

Anxiety enhances pain in a model of osteoarthritis and is associated with altered endogenous opioid function and reduced opioid analgesia

Lillywhite

Woodhams

Watson

et al. 2020

Preprint

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Title (20 words): Anxiety enhances pain in a model of osteoarthritis and is 1 associated with altered endogenous opioid function and reduced opioid 2 analgesia 3 4 Abstract 238 words, introduction 629 words, discussion 1138 words 26 27 28 29 30 31 32 Abstract (239) 34Chronic pain states such as osteoarthritis (OA) are often associated with negative 35 affect, including anxiety and depression. This is, in turn, associated with greater 36 opioid analgesic use, potentially contributing to current and future opioid crises. We 37 utilise an animal model to investigate the neurobiological mechanisms underlying 38 increased opioid use associated with high anxiety and chronic pain. 39 Combining a genetic model of negative affect, the Wistar Kyoto (WKY) rat, and intra-40 articular injection of monosodium iodoacetate (MIA; 1mg), our model of high anxiety 41 and augmented OA-like pain behaviour mirrors the clinical problem. Effects of 42 morphine (0.5-6mg.kg -1 ) on pain behaviour and spinal nociceptive neuronal activity 43 were determined in WKY rats, and normo-anxiety Wistar rats, 3 weeks after MIA 44 injection. WKY rats developed augmented OA-like pain, and had blunted inhibitory 45 responses to morphine, when compared to Wistar rats. Potential alterations in 46 endogenous opioid function were probed via systemic blockade of opioid receptors 47 Significance Statement (116) 56 Chronic pain affects large numbers of people, and pain management often relies on 57 poorly effective opioid analgesics, the iatrogenic effects of which are increasingly 58 recognised. The endogenous opioid system -the target for exogenous opioid 59 analgesics -plays key roles in emotional affective states and pain control, but the 60 complex interplay between anxiety, chronic pain, and endogenous opioid system 61 function is challenging to study in people. Here, we have addressed this using a 62 clinically-relevant experimental model. Anxiety-like behaviour was associated with 63 increased chronic arthritis-like pain behaviour, altered opioid receptor function, and 64 reduced efficacy of opioid analgesics. We provide new evidence, which may explain 65 why chronic pain patients with comorbid high anxiety have higher opioid analgesic 66 use. 67Studies were in accordance with UK Home Office Animals (Scientific Procedures) 126 Act (1986) and ARRIVE guidelines (Kilkenny et al., 2012). A total of 183 male rats 127 were used for this study; Wistar n = 97 (Charles River, Margate, United Kingdom), & 128Wistar Kyoto n = 86 (WKY; Envigo, Bicester, United Kingdom). Males only were 129 used to reduce variability in the data, and to maintain consistency with previous 130 studies characterising this model. Wistar rats were used as the most genetically 131 similar control strain to WKY. Rats were group housed by strain in groups of 4 on a 132 12-hour light/dark cycle in a specific pathogen-free environment with ad libitum 133 access to standard rat chow and water. Treatments were randomly assigned to rats, 134 and experimenters were blinded to all treatment group...

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Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

Cited by 359 publications

References 119 publications

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Commentary on Hayes et al. (2020): The harms of opioid dose escalation in the management of chronic non‐cancer pain

Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study

Anxiety enhances pain in a model of osteoarthritis and is associated with altered endogenous opioid function and reduced opioid analgesia

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