�Opioid medications are essential for helping to lighten all types of serious pain. However, relatively recent evidence suggests that in some patients they rump paradoxically exasperate the annoyance.
"Actually, this possible negative effect of opioids, such as morphine, to reason increased sensitivity to hurting was observed in the 19th Century," says Peggy Compton, RN, PhD. "Today, we call this opioid-induced hyperalgesia, or OIH."
Compton is an Associate Professor of Nursing at the UCLA School of Nursing, Los Angeles, and a well-known researcher and writer in the pain direction field. Her extensive critical review of the clinical grounds on OIH, exclusively for Pain Treatment Topics and published at the Pain-Topics.org website, is titled "The OIH Paradox: Can Opioids Make Pain Worse?"
The full text file can be accessed 'here.
Fortunately, it seems that OIH does non arise in the majority of patients taking opioid analgesics, just when it does occur it can be difficult to wangle. In addition to OIH, pain increasing during opioid therapy hindquarters indicate several other weather that must be considered, including: 1) worsening pain-causing disease, 2) tolerance to opioid effects, 3) opioid withdrawal symptoms, or 4) pseudoaddiction (opioid-seeking due to unrelieved painfulness). For these conditions, increasing the opioid dose unremarkably helps relieve pain.
A patient world Health Organization is addicted to opioids may kvetch of declension pain just may not be helped by increasing the opioid dose. In fact, signs of habituation may emerge further, such as difficulty controlling opioid use, a preoccupation with obtaining opioids, or other misbehavior.
In the typeface of OIH, increasing the opioid dose will in reality make the pain worsened. Often, the pain is difficult for the patient role to report and can spread beyond the original point of pain. According to Compton's review, several strategies may help forestall OIH or to administer with OIH if it occurs:
-- The opioid dose should be kept as low as is clinically in force for managing pain.
-- Additional medications can be used to help downplay the demand for opioids, such as COX-2 inhibitors, dextromethorphan, and others.
-- Long-acting opioids are preferred over shorter-acting formulations for chronic hurting.
-- If a peculiar opioid becomes ineffective, it is much helpful to rotate to a wholly different opioid drug (synthetic heroin is especially useful for opioid rotation).
-- New research suggests combining low-doses of opioid antagonists (eg, naltrexone) with opioid therapy to counteract development of OIH.
Compton observes that there are still many unanswered questions about OIH, and research investigations are ongoing. Meanwhile, it is essential for healthcare providers to carefully monitor patients' responses to opioid therapy and recognise that various opioid-related responses other than OIH crapper lessen opioid-analgesic effectiveness. In some cases, higher dosing is requisite; however, if OIH occurs, other strategies should be employed to provide patients the pain relief they need and deserve.
Pain Treatment Topics and the associated Pain-Topics.org website provide open and free access to noncommercial, evidence-based clinical news, information, research, and education on the causes and effective treatment of the many types of pain conditions. It is independently produced and presently supported by an unrestricted educational ulysses Simpson Grant from Covidien/Mallinckrodt Inc., St. Louis, MO, a leading manufacturer of generic opioid analgesic products.
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