open access

Vol 15, No 3 (2021)
Review paper
Published online: 2021-05-20
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Adverse effects of opioid analgesics from the central nervous system

Krzysztof Wojtasik-Bakalarz1, Jarosław Woroń1, Marcin Siwek2
DOI: 10.5603/PMPI.2021.0013
·
Palliat Med Pract 2021;15(3):241-247.
Affiliations
  1. Zakład Farmakologii Klinicznej Katedry Farmakologii UJ CM w Krakowie, Ul. Grzegórzecka 16, 31-531 Kraków, Poland
  2. Zakład Zaburzeń Afektywnych Katedry Psychiatrii UJ CM., Kopernika 21a, 31-501 Kraków, Poland

open access

Vol 15, No 3 (2021)
Review paper
Published online: 2021-05-20

Abstract

Opioid analgesic drugs are widely used in the treatment of moderate to severe pain as well as symptomatic
treatment of dyspnoea. However, the use of opioids may cause central adverse effects, such as delirium,
cognitive impairment, sedation, hallucinations, myocloni, seizures, hyperalgesia, sleep and mood disorders.
The ability to diagnose and properly manage the above adverse effects is important for the proper
treatment of patients receiving opioid analgesics.

Abstract

Opioid analgesic drugs are widely used in the treatment of moderate to severe pain as well as symptomatic
treatment of dyspnoea. However, the use of opioids may cause central adverse effects, such as delirium,
cognitive impairment, sedation, hallucinations, myocloni, seizures, hyperalgesia, sleep and mood disorders.
The ability to diagnose and properly manage the above adverse effects is important for the proper
treatment of patients receiving opioid analgesics.

Get Citation

Keywords

hyperalgesia, delirium, opioid analgesic drugs, adverse effects, neurotoxicity

About this article
Title

Adverse effects of opioid analgesics from the central nervous system

Journal

Palliative Medicine in Practice

Issue

Vol 15, No 3 (2021)

Article type

Review paper

Pages

241-247

Published online

2021-05-20

Page views

6716

Article views/downloads

1634

DOI

10.5603/PMPI.2021.0013

Bibliographic record

Palliat Med Pract 2021;15(3):241-247.

Keywords

hyperalgesia
delirium
opioid analgesic drugs
adverse effects
neurotoxicity

Authors

Krzysztof Wojtasik-Bakalarz
Jarosław Woroń
Marcin Siwek

References (50)
  1. Valentino RJ, Volkow ND, Valentino RJ, et al. Untangling the complexity of opioid receptor function. Neuropsychopharmacology. 2018; 43(13): 2514–2520.
  2. Jean YK, Gitlin MC, Reynolds J, et al. Tramadol-associated hallucinations: a systematic review and narrative synthesis of their pathophysiology, diagnosis, and treatment. Can J Anaesth. 2020; 67(3): 360–368.
  3. Lim KH, Nguyen NN, Qian Yu, et al. Frequency, Outcomes, and Associated Factors for Opioid-Induced Neurotoxicity in Patients with Advanced Cancer Receiving Opioids in Inpatient Palliative Care. J Palliat Med. 2018; 21(12): 1698–1704.
  4. Kullgren J, Le Vy, Wheeler W, et al. Incidence of hydromorphone-induced neuroexcitation in hospice patients. J Palliat Med. 2013; 16(10): 1205–1209.
  5. Hshieh TT, Inouye SK, Oh ES, et al. Delirium in the Elderly. Psychiatr Clin North Am. 2018; 41(1): 1–17.
  6. Clegg A, Young JB, Clegg A, et al. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011; 40(1): 23–29.
  7. Morita T, Tei Y, Tsunoda J, et al. Underlying Pathologies and Their Associations With Clinical Features in Terminal Delirium of Cancer Patients. Journal of Pain and Symptom Management. 2001; 22(6): 997–1006.
  8. Nguyen TH, Atayee RS, Derry KL, et al. Characteristics of Hospitalized Patients Screening Positive for Delirium. Am J Hosp Palliat Care. 2020; 37(2): 142–148.
  9. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults, American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015; 220(2): 136–48.e1.
  10. Slatkin N, Rhiner M, Slatkin N, et al. Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report. J Pain Symptom Manage. 2004; 27(3): 268–273.
  11. Swart LM, van der Zanden V, Spies PE, et al. The Comparative Risk of Delirium with Different Opioids: A Systematic Review. Drugs Aging. 2017; 34(6): 437–443.
  12. Vella-Brincat J, Macleod AD, Vella-Brincat J, et al. Adverse effects of opioids on the central nervous systems of palliative care patients. J Pain Palliat Care Pharmacother. 2007; 21(1): 15–25.
  13. Hughes CG, Boncyk CS, Culley DJ, et al. Perioperative Quality Initiative (POQI) 6 Workgroup, Perioperative Quality Initiative (POQI) 6 Workgroup. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg. 2020; 130(6): 1572–1590.
  14. Kapstan. Delirium due to Buprenorphine therapy. Case Rep Clin Pract Rev. 2003; 4: 182–185.
  15. Ito Go, Kanemoto K, Ito Go, et al. A case of topical opioid-induced delirium mistaken as behavioural and psychological symptoms of dementia in demented state. Psychogeriatrics. 2013; 13(2): 118–123.
  16. Ikegaki J, Kizawa Y, Ikegaki J, et al. Delirium Prolonged for Three Days after Addition of One Dose of 5 mg Methadone to Ongoing Opioid. J Palliat Med. 2020; 23(2): 164.
  17. Benítez-Rosario MA, Feria M, Salinas-Martín A, et al. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. Cancer. 2004; 101(12): 2866–2873.
  18. Stollenwerk A, Sohns M, Heisig F, et al. Review of Post-Marketing Safety Data on Tapentadol, a Centrally Acting Analgesic. Adv Ther. 2018; 35(1): 12–30.
  19. Bush SH, Tierney S, Lawlor PG, et al. Clinical Assessment and Management of Delirium in the Palliative Care Setting. Drugs. 2017; 77(15): 1623–1643.
  20. Morita T, Takigawa C, Onishi H, et al. Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology (PRPP) Study Group, Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology (PRPP) Study Group. Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial. J Pain Symptom Manage. 2005; 30(1): 96–103.
  21. Santiago-Palma J, Khojainova N, Kornick C, et al. Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl. Cancer. 2001; 92(7): 1919–1925, doi: 10.1002/1097-0142(20011001)92:7<1919::aid-cncr1710>3.0.co;2-g.
  22. Dhingra L, Ahmed E, Shin J, et al. Cognitive Effects and Sedation. Pain Med. 2015; 16 Suppl 1: S37–S43.
  23. Kendall SE, Sjøgren P, Pimenta CA, et al. The cognitive effects of opioids in chronic non-cancer pain. Pain. 2010; 150(2): 225–230.
  24. Stone P, Minton O, Stone P, et al. European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus? Palliat Med. 2011; 25(5): 431–441.
  25. Sivanesan E, Gitlin MC, Candiotti KA, et al. Opioid-induced Hallucinations: A Review of the Literature, Pathophysiology, Diagnosis, and Treatment. Anesth Analg. 2016; 123(4): 836–843.
  26. Janssen S, Bloem BR, van de Warrenburg BP, et al. The clinical heterogeneity of drug-induced myoclonus: an illustrated review. J Neurol. 2017; 264(8): 1559–1566.
  27. Bae SY, Lee SJ, Bae SY, et al. Negative myoclonus associated with tramadol use. Yeungnam Univ J Med. 2020; 37(4): 329–331.
  28. Woodward OB, Naraen S, Naraen A, et al. Opioid-induced myoclonus and hyperalgesia following a short course of low-dose oral morphine. Br J Pain. 2017; 11(1): 32–35.
  29. Isoardo G, Zibetti M, Troni W, et al. Myoclonus of probable spinal origin as a potential side effect of tramadol. A case report. J Neurol. 2005; 252(7): 852.
  30. Han PKJ, Arnold R, Bond G, et al. Myoclonus secondary to withdrawal from transdermal fentanyl: case report and literature review. J Pain Symptom Manage. 2002; 23(1): 66–72.
  31. Nakhaee S, Amirabadizadeh A, Brent J, et al. Tramadol and the occurrence of seizures: a systematic review and meta-analysis. Crit Rev Toxicol. 2019; 49(8): 710–723.
  32. Mégarbane B, Weinberg GL, Mégarbane B, et al. Hypotension and status epilepticus in relation to intrathecal morphine administration. Am J Emerg Med. 2020; 38(8): 1682–1683.
  33. Oviedo-Joekes E, Guh D, Brissette S, et al. Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence: A Randomized Clinical Trial. JAMA Psychiatry. 2016; 73(5): 447–455.
  34. Nam MH, Won W, Han KS, et al. Signaling mechanisms of μ-opioid receptor (MOR) in the hippocampus: disinhibition versus astrocytic glutamate regulation. Cell Mol Life Sci. 2021; 78(2): 415–426.
  35. Mercadante S, Arcuri E, Santoni A, et al. Opioid-Induced Tolerance and Hyperalgesia. CNS Drugs. 2019; 33(10): 943–955.
  36. Lee M, Lee M. A Comprehensive Review of Opioid-InducedHyperalgesia. Pain Physician. 2011; 14: 145–161.
  37. Eacret D, Veasey SC, Blendy JA, et al. Bidirectional Relationship between Opioids and Disrupted Sleep: Putative Mechanisms. Mol Pharmacol. 2020; 98(4): 445–453.
  38. Cao M, Javaheri S, Cao M, et al. Effects of Chronic Opioid Use on Sleep and Wake. Sleep Med Clin. 2018; 13(2): 271–281.
  39. Tripathi R, Rao R, Dhawan A, et al. Opioids and sleep - a review of literature. Sleep Med. 2020; 67: 269–275.
  40. Martins SS, Fenton MC, Keyes KM, et al. Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychol Med. 2012; 42(6): 1261–1272.
  41. Scherrer JF, Svrakic DM, Freedland KE, et al. Prescription opioid analgesics increase the risk of depression. J Gen Intern Med. 2014; 29(3): 491–499.
  42. Scherrer JF, Salas J, Copeland LA, et al. Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations. Ann Fam Med. 2016; 14(1): 54–62.
  43. Scherrer JF, Salas J, Copeland LA, et al. Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients. J Pain. 2016; 17(4): 473–482.
  44. Schaffer CB, Nordahl TE, Schaffer LC, et al. Mood-elevating effects of opioid analgesics in patients with bipolar disorder. J Neuropsychiatry Clin Neurosci. 2007; 19(4): 449–452.
  45. Ceylan D, Kaçar M, Ulaş H, et al. Manic episodes associated with tramadol: a case report. J Clin Psychopharmacol. 2015; 35(1): 111–113.
  46. Ansermot N, Chocron O, Herrera F, et al. Severe manic episode associated with tramadol in a patient with recurrent depressive disorder. J Clin Psychopharmacol. 2015; 35(2): 203–204.
  47. Gonzalez-Pinto A, Imaz H, De Heredia JL, et al. Mania and tramadol-fluoxetine combination. Am J Psychiatry. 2001; 158(6): 964–965.
  48. Hefzi N, Grekin J, Ahmed A, et al. Mania induced by tramadol-venlafaxine combination. J Opioid Manag. 2019; 15(4): 342–344.
  49. Sande TA, Laird BJA, Fallon MT, et al. The Management of Opioid-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review. J Palliat Med. 2019; 22(1): 90–97.
  50. Smith HS, Laufer A, Smith HS, et al. Opioid induced nausea and vomiting. Eur J Pharmacol. 2014; 722: 67–78.

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