Opioid-induced hyperalgesia as a problem in pain management. Mechanisms of onset, diagnosis and treatment

Zbigniew Zylicz; Małgorzata Krajnik

Vol 6, No 1 (2007)

Review articles

Published online: 2007-02-22

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Opioid-induced hyperalgesia as a problem in pain management. Mechanisms of onset, diagnosis and treatment

Zbigniew Zylicz, Małgorzata Krajnik

Advances in Palliative Medicine 2007;6(1):37-44.

Vol 6, No 1 (2007)

Review articles

Published online: 2007-02-22

Abstract

Opioids have been used for centuries to control pain. One of the problems with their use is the development of tolerance in some patients. This problem is usually solved by an increase in the dose. However, this does not solve all the difficulties encountered. In some patients, the opioid doses needs rise very quickly. It seems that this phenomenon depends on changes in the opioid receptors and on the organization of the functions of the central nervous system. This phenomenon is known as opioid-induced hyperalgesia. Changes may include the facilitation of pain conveyance which may more or less counteract the analgesic effect of the same drug. Until now, several putative mechanisms have been identified. Here we shall explore the changes of opioid receptors and changes in the glutaminergic system. In addition, the spinal cord and probably also the liver are producing a specific peptide, Dynorphin A, which has an excitatory effect. The organization and function of the On-Off cells in the brain are also changed. In this article, we discuss strategies for the treatment of opioid-induced hyperalgesia. These strategies have the potential to improve the quality of opioid analgesia.