Tolerancia aguda a opioides e hiperalgesia postoperatoria tras breve infusión de remifentanilo controlados con analgesia multimodal

Sáenz, Manuel Cortiñas; Pardo, M. Gerónimo; Sáenz, M.L. Cortiñas; Vallecillo, M.T. Hernández; Martí, M.L. Ibarra; Cerdán, C.M. Mateo

doi:10.1016/s0034-9356(08)70496-1

Cited by 1 publication

(1 citation statement)

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“…The effectiveness of opioid analgesia may be influenced by the occurrence of opioid tolerance, opioid-induced hyperalgesia, a history of substance abuse, as well as other factors such as genetics and comorbid mental illness [11] [7] [25]. At the center of this debate are the issues as to whether 1) opioid therapy is effective for pain relief and 2) opioid dose escalation during a prolonged course of opioid therapy would improve pain relief.…”

Section: Introductionmentioning

confidence: 99%

Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

Chen

Seefeld

et al. 2013

The Journal of Pain

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Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital (MGH) Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score, 2) gender and age differences in response to opioid therapy, and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome. Perspectives The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic non-malignant pain conditions.

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Section: Introductionmentioning

confidence: 99%