J Korean Med Assoc.  2014 Jan;57(1):41-46. 10.5124/jkma.2014.57.1.41.

Opioid-induced hyperalgesia

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea. leehee@ewha.ac.kr

Abstract

Perioperative opioid-induced hyperalgesia (OIH) can be defined as the "increased perception of pain after opioid-based anesthesia and surgery" since hyperalgesia is defined as "increased pain from a stimulus that normally provokes pain." OIH has been identified mainly after remifentanil-based anesthesia in surgical patients given the high dose and rapid withdrawal used. The mechanisms of OIH have been postulated mainly by the cellular-level adaptation in internalization of the receptors and downregulation of intracellular coupling, upregulation of spinal dynorphins, and activation of N-methyl-D-aspartate receptors have been postulated as well. The clinical aspects of OIH with various causes, especially remifentanil, have been investigated. Pros and cons related to remifentanil-induced hyperalgesia have been suggested. The dose and duration of remifentanil used in surgery and anesthesia can be the appropriate factors for OIH, including the way of setting for the control groups of those studies, and the methods for evaluating the pain. Opioids remain one of the most powerful pain killers for acute pain management. Opioids are sometimes necessary for perioperative analgesia, but OIH can be an unavoidable risk. Ongoing interest in OIH and the development of anesthesia optimized for its prevention will increase the quality of perioperative life.

Keyword

Drug tolerance; Hyperalgesia; Opioid

MeSH Terms

Acute Pain
Analgesia
Analgesics, Opioid
Anesthesia
Down-Regulation
Drug Tolerance
Dynorphins
Humans
Hyperalgesia*
Methods
Receptors, N-Methyl-D-Aspartate
Up-Regulation
Analgesics, Opioid
Dynorphins
Receptors, N-Methyl-D-Aspartate

Cited by  1 articles

Effect of intraoperative infusion of ketamine on remifentanil-induced hyperalgesia
Eunji Choi, Heeseung Lee, Hahck Soo Park, Guie Yong Lee, Youn Jin Kim, Hee-Jung Baik
Korean J Anesthesiol. 2015;68(5):476-480.    doi: 10.4097/kjae.2015.68.5.476.


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