Opioid-Induced Hyperalgesia within the Nonsurgical Setting: A Systematic Evaluation.
Am J Ther. 2018 Jan 31;:
Authors: Yang DZ, Sin B, Beckhusen J, Xia D, Khaimova R, Iliev I
BACKGROUND: Opioid-induced hyperalgesia (OIH) is a phenomenon that causes an elevated ache sensitization and notion of ache to noxious stimuli secondary to opioid publicity. Whereas this scientific impact has been described within the surgical setting, it’s unclear if OIH happens within the nonsurgical setting.
STUDY QUESTION: To assessment the obtainable literature which evaluated OIH in nonsurgical settings.
DATA SOURCES: A complete literature search was carried out utilizing PubMed (January 1946-July 2017) utilizing a wide range of key phrases for OIH. This assessment included randomized managed trials with aims to determine OIH within the nonsurgical setting. The scientific outcomes of curiosity had been identification of OIH, antagonistic occasions, and affect of OIH on opioid consumption.
RESULTS: The search recognized eight research that fulfilled the standards. Six research enrolled wholesome male volunteers, 1 examine used power low-back sufferers, and one other used heroin-dependent treatment-seeking adults. Research used varied opioids and dosages, together with remifentanil, alfentanil, fentanyl, morphine, methadone, and buprenorphine. Three major experimental ache induction fashions had been used to guage for OIH. Measured outcomes included hyperalgesia space, ache threshold, and ache tolerance. All 5 research that used stimulation mannequin recognized OIH as a big end result. Nonetheless, solely 2 of 5 research utilizing the chilly pressor mannequin and 1 of three research utilizing the warmth pressor mannequin recognized OIH. Not one of the trials explored scientific outcomes, equivalent to results on opioid consumption.
CONCLUSIONS: Most included research recognized OIH as a big end result throughout the nonsurgical setting. Nonetheless, as a consequence of conflicting conclusions and varied limitations, the scientific affect of OIH couldn’t be assessed. Clinicians ought to monitor for results of OIH within the nonoperative setting as a result of there may be inadequate proof from the obtainable literature to conclude that OIH is persistently noticed on this setting.
PMID: 29726847 [PubMed – as supplied by publisher]