Review of the Performance of Quantitative Sensory Testing Methods to Detect Hyperalgesia in Chronic Pain Patients on Long-term Opioids
- 1 March 2015
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesiology
- Vol. 122 (3), 677-685
- https://doi.org/10.1097/aln.0000000000000530
Abstract
Background: Opioid-induced hyperalgesia is a clinical syndrome whereby patients on long-term opioids become more sensitive to pain while taking opioids. Opioid-induced hyperalgesia is characterized by increased pain intensity over time, spreading of pain to other locations, and increased pain sensation to external stimuli. To characterize opioid-induced hyperalgesia, laboratory methods to measure hyperalgesia have been developed. To determine the performance of these methods, the authors conducted a systematic review of clinical studies that incorporate measures of hyperalgesia in chronic pain patients on long-term opioids. Methods: PubMed and Cochrane databases were searched (terms: opioid induced hyperalgesia, study or trial, and long-term or chronic). Studies published in English were selected if they were conducted in chronic pain patients on long-term opioids and incorporated measures of hyperalgesia; acute/single-dose studies and/or conducted in healthy volunteers were excluded. Results: Fourteen articles made the final selection (11 were selected from the search and 3 others were found from additional sources); there was one randomized controlled trial, one prospective controlled study, three prospective uncontrolled studies, and nine cross-sectional observation studies. Hyperalgesia measurement paradigms used included cold pain, heat pain, pressure pain, electrical pain, ischemic pain, and injection pain. Although none of the stimuli were capable of detecting patients’ hyperalgesia, heat pain sensitivity showed some promising results. Conclusions: None of the measures reviewed herein met the criteria of a definitive standard for the measurement of hyperalgesia. Additional studies that use improved study design should be conducted.Keywords
This publication has 15 references indexed in Scilit:
- Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysisBritish Journal of Anaesthesia, 2014
- Analgesic tolerance without demonstrable opioid-induced hyperalgesia: A double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back painPain, 2012
- Longitudinal Observation of Changes in Pain Sensitivity during Opioid Tapering in Patients with Chronic Low-Back PainPain Medicine, 2011
- Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid MisuseThe Journal of Pain, 2011
- Pharmacological Treatment of Opioid-Induced Hyperalgesia: A Review of the EvidenceJournal of Pain & Palliative Care Pharmacotherapy, 2011
- Multi-mechanistic analgesia for opioid-induced hyperalgesiaJournal of Clinical Pharmacy & Therapeutics, 2011
- Associations between Heat Pain Perception and Opioid Dose among Patients with Chronic Pain Undergoing Opioid TaperingPain Medicine, 2010
- Altered quantitative sensory testing outcome in subjects with opioid therapyPain, 2009
- Oral opioid use alters DNIC but not cold pain perception in patients with chronic pain – New perspective of opioid-induced hyperalgesiaPain, 2008
- Changes in morphine analgesia and side effects during daily subcutaneous administration in healthy volunteersPain, 2008