Too Much of a Good Thing? Treating the Emerging Syndrome of Opioid-Induced Hyperalgesia

Pain is the primary reason individuals seek health care, and chronic pain is the leading cause of disability. Patients with chronic pain often require treatment with strong analgesics, including opioids. Mounting evidence shows that very high opioid doses or rapidly escalating doses may lead to a paradoxical syndrome of increasing pain that is nonresponsive to opioid therapy. A review of the published literature describing the phenomenon of opioid-induced hyperalgesia was conducted, and management strategies were reviewed. A systematic search of PubMed using Medical Subject Headings terms to narrow search criteria identified 3 treatment strategies. The strategies evaluated in this literature review include opioid rotation, coadministration of N-methyl-D-aspartate receptor antagonists, and coadministration of opioid antagonists. Further research is needed to draw conclusive recommendations. As of now, the safest and most effective treatment strategy showing the best evidence involves the use of opioid rota...