Fairview Pain Management Center, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Pain Med. 2010 Dec;11(12):1819-26. doi: 10.1111/j.1526-4637.2010.00973.x. Epub 2010 Oct 28.
Understanding the actions of opioids now encompasses pronociceptive as well as antinociceptive mechanisms. Opioid-induced hyperalgesia (OIH) refers to increased pain sensitivity due to high-dose or prolonged opioid exposure. It has become more important as patients with pain remain on opioids at higher doses for longer periods of time. One setting that highlights the dilemma of OIH is in the opioid-tolerant patient who is hospitalized for painful medical conditions or procedures and is unable to achieve adequate analgesia despite escalating opioid doses. This patient population often requires agents that act synergistically with opioids through different mechanisms to achieve analgesia. Dexmedetomidine is an alpha-2 adrenergic agonist that has been shown to synergize with opioids.
Tertiary care hospital.
Case series.
Eleven hospitalized patients with OIH received dexmedetomidine to improve pain control and to lower opioid doses while avoiding opioid withdrawal.
A total of 64% (7/11) had substantial reductions in their baseline opioid doses at the time of discharge.
The cases presented provide support for the clinical utility of alpha-2 agonists during opioid dose reduction in patients with OIH as well suggesting that they may contribute to the recovery of normal nociceptive and antinociceptive responses.
理解阿片类药物的作用现在包括伤害感受性和抗伤害感受性机制。阿片类药物引起的痛觉过敏（OIH）是指由于高剂量或长时间暴露于阿片类药物而导致的疼痛敏感性增加。随着疼痛患者需要长时间服用更高剂量的阿片类药物，OIH 变得更加重要。在因疼痛而住院的阿片类药物耐受患者中，OIH 问题尤为突出，尽管阿片类药物剂量不断增加，但仍无法获得足够的镇痛效果。这类患者人群通常需要通过不同机制与阿片类药物协同作用的药物来实现镇痛。右美托咪定是一种 α-2 肾上腺素能激动剂，已被证明可与阿片类药物协同作用。
三级护理医院。
病例系列。
11 名患有 OIH 的住院患者接受右美托咪定治疗，以改善疼痛控制并降低阿片类药物剂量，同时避免阿片类药物戒断。
出院时，共有 64%（7/11）的患者的阿片类药物基线剂量大幅减少。
所提供的病例为 OIH 患者在减少阿片类药物剂量过程中使用 α-2 激动剂的临床应用提供了支持，并表明它们可能有助于恢复正常的伤害感受和抗伤害感受反应。
