Zöllner C
Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland.
Anaesthesist. 2010 Nov;59(11):983-6, 988-93. doi: 10.1007/s00101-010-1803-x.
Opioids are the most potent drugs for treatment of acute and chronic pain. However, accumulating evidence suggests that opioids may paradoxically also enhance pain, often referred to as opioid-induced hyperalgesia. Opioid-induced hyperalgesia is defined as an increased sensitivity to pain or a decreased pain threshold in response to opioid therapy. Several mechanisms have been proposed to support opioid-induced hyperalgesia. However, it remains unclear whether opioid-induced hyperalgesia develops during continuous chronic application of opioids or on their withdrawal. This review provides a comprehensive summary of clinical research concerning opioid-induced hyperalgesia and the molecular mechanisms of opioid withdrawal and opioid tolerance and other potential mechanisms which might induce hyperalgesia during opioid therapy will be discussed. The status quo of our knowledge will be summarized and the clinical relevance of opioid-induced hyperalgesia will be discussed.
阿片类药物是治疗急慢性疼痛最有效的药物。然而，越来越多的证据表明，阿片类药物可能反常地也会加重疼痛，通常称为阿片类药物诱导的痛觉过敏。阿片类药物诱导的痛觉过敏被定义为对疼痛的敏感性增加或对阿片类药物治疗的疼痛阈值降低。已经提出了几种机制来支持阿片类药物诱导的痛觉过敏。然而，阿片类药物诱导的痛觉过敏是在阿片类药物持续长期应用期间还是在其戒断时发生仍不清楚。本综述全面总结了关于阿片类药物诱导的痛觉过敏的临床研究，并将讨论阿片类药物戒断和阿片类药物耐受的分子机制以及其他可能在阿片类药物治疗期间诱导痛觉过敏的潜在机制。我们知识的现状将被总结，并将讨论阿片类药物诱导的痛觉过敏的临床相关性。
