Definition: “Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.” PP 2011
OIH occurs in patients receiving high doses of parenteral opioids such as morphine. Patients often report progressive worsening pain and develop diffuse pain away from the site of the original pain. Patients may report pain that occurs when caregivers touch them. This perception of pain in the absence of a painful stimulus is called allodynia. Allodynia is typical in opioid-induced hyperalgesia.
Treatment
-Wean off opioids completely OR Reduce the current opioid dosage.
-Sometimes, eliminating the current opioid and starting another opioid helps.
-Another option to manage OIH is to rotate to a different class of opioids.
-Add non-opioid pain meds if appropriate.
Reference
Pain Med. 2015 Oct;16 Suppl 1:S32-6. Opioid-Induced Hyperalgesia. https://www.ncbi.nlm.nih.gov/pubmed/26461074
Pain Physician. 2011 Mar-Apr;14(2):145-61. A comprehensive review of opioid-induced hyperalgesia.
Pharmacologic management of pain at the end of life. Am Fam Physician 2014;90(1):26-32.