Opioid-Induced Hyperalgesia PDF

Preface

Despite the extensive effort over several decades searching for new pharmacological tools for clinical pain treatment, opioid analgesics remain the mainstay of contemporary pain medicine. Opioid analgesics are extensively used for the management of both acute and chronic pain including cancer-related pain. Opioid analgesics have a number of side effects including respiratory depression, miosis, nausea, vomiting, constipation, biliary tract spasm, urinary retention, hypotension, dizziness, dysphoria, metal status change, and pruritis. However, most of these side effects are dose dependent and manageable in the clinical setting.

Other opioid-related clinical issues such as opioid tolerance, dependence, and addiction have limited the use of opioid analgesics in pain medicine, particularly for chronic pain management. More recently, both preclinical and clinical studies have shown that chronic exposure to opioid analgesics can alter the response of the central nervous system to nociceptive input leading to the increased pain sensitivity, which is often referred to as opioid-induced hyperalgesia. Both preclinical and clinical findings suggest that opioid analgesics that are intended to reduce pain may paradoxically increase pain under certain clinical conditions, calling for a new approach to managing clinical opioid therapy.

This book is intended to provide clinically oriented discussions on the diagnosis and management of opioid-induced hyperalgesia. Clinical practitioners who are currently involved or interested in pain management are intended primary readers, including such specialties as anesthesiology, pain medicine, neurology, oncology, palliative care, addiction medicine, primary care, rheumatology, and surgery.

The first chapter (by Dr Mao) provides an overview on the concept of opioid-induced hyperalgesia, followed by a focused discussion on possible cellular mechanisms of opioid-induced hyperalgesia and its relation to opioid tolerance (by Dr Ueda). The third chapter (by Drs Angst, Chu, Clark) provides readers with a thorough discussion on the clinical features of opioid-induced hyperalgesia and their impact in pain medicine. The clinical utility of quantitative sensory testing in the diagnosis of opioid-induced hyperalgesia is the focus of chapter 4 (by Dr Edwards), which gives the detailed accounts on the history, methodology, and clinical utility of quantitative sensory testing.

The clinical interaction between addiction and opioid therapy is a vitally important issue in pain medicine and addiction medicine. Chapter 5 (by Dr Ballantyne) and chapter 6 (by Drs Ling and Compton) focus on the relationship between addiction and clinical features and management of opioid-induced hyperalgesia. These two chapters provide profound details on the neurobiology, philosophy, clinical features, and clinical management of the interaction between addiction and opioid-induced hyperalgesia.

Chapters 7 and 8 present practical guidelines on the clinical diagnosis and management of opioid-induced hyperalgesia under various clinical circumstances, including primary care settings (by Dr McCarberg) and perioperative care (by Drs Crooks and Cohen). Additional approaches to managing opioid-induced hyperalgesia in other clinical circumstances are the topics of chapters 9, 10, and 11, which include discussions on the role of ketamine (by Dr Vorobeychik), opioid rotation and tapering (by Dr Smith), and adjuvant medications (by Drs Giampetro and Vorobeychik). The final chapter (by Dr Mao) summarizes clinical differential diagnosis between opioid-induced hyperalgesia and opioid tolerance and discusses future research directions on this important clinical phenomenon.

I would like to express my deep appreciation for my colleagues in this field, who have contributed to the work of this book project and/or basic science and clinical research on this important topic.