阿片类药物诱导的痛觉过敏（OIH）。

Opioid-induced hyperalgesia (OIH).

作者信息

Leal Plínio da Cunha, Clivatti Jefferson, Garcia João Batista Santos, Sakata Rioko Kimiko

机构信息

Department of Anesthesiology, Pain, and Intensive Care Medicine of the Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM/UNIFESP), SP.

出版信息

Rev Bras Anestesiol. 2010 Nov-Dec;60(6):639-47, 355-9. doi: 10.1016/S0034-7094(10)70080-5.

DOI:10.1016/S0034-7094(10)70080-5

PMID:21146061

Abstract

BACKGROUND AND OBJECTIVES

Opioids are commonly used for pain control; however, they can cause hyperalgesia. The reason why this can happen is not known. The objective of this review was to describe the mechanisms, factors implicated, and drug modulation.

The factors implicated in the development of opioid-induced hyperalgesia (OIH), such as duration of use, dose, and type of opioids are described. Mechanisms involved include the glutamatergic system and N-methyl-D-aspartate receptors (NMDA), spinal cyclooxygenase (COX) activation, excitatory amino acids, dynorphin, cytokines and chemokines; prostaglandins, and descending facilitation. Modulation of hyperalgesia could be done through: NMDA receptor antagonists, alpha2-adrenergic agonists, and COX inhibitors.

CONCLUSIONS

This is a very complex subject, which involves a series of pathophysiological mechanisms that could contribute for OIH and patient discomfort, bringing disastrous consequences.

摘要

背景与目的

阿片类药物常用于控制疼痛；然而，它们可能会导致痛觉过敏。其发生原因尚不清楚。本综述的目的是描述其机制、相关因素以及药物调节作用。

内容

描述了与阿片类药物诱导的痛觉过敏（OIH）发生相关的因素，如使用时长、剂量和阿片类药物类型。涉及的机制包括谷氨酸能系统和N-甲基-D-天冬氨酸受体（NMDA）、脊髓环氧化酶（COX）激活、兴奋性氨基酸、强啡肽、细胞因子和趋化因子；前列腺素以及下行易化作用。痛觉过敏的调节可通过：NMDA受体拮抗剂、α2-肾上腺素能激动剂和COX抑制剂来实现。