Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA.
J Clin Pharm Ther. 2012 Apr;37(2):125-7. doi: 10.1111/j.1365-2710.2011.01264.x. Epub 2011 Apr 19.
The phenomenon of opioid-induced hyperalgesia (OIH), an increased sensitivity to pain attributed to the very opioid drugs administered to manage the pain, is well established in animal models, and there is concern that it also occurs in patients. Our objective is to briefly summarize the basic science and clinical evidence about OIH as background to consider the possible benefit of using a multi-mechanistic analgesic approach.
It is unclear how OIH occurs, or even why; presumably, it is part of an adaptive response. But development of OIH poses a serious treatment dilemma. OIH differs from tolerance, which also presents as reduced analgesic effect, in that tolerance is addressed by judicious and monitored increase in opioid dose, but OIH would be treated by a decrease in opioid dose. Therefore, it is important to avoid induction of OIH. Currently, it is not clear which patients are at greater risk of developing OIH, or which drugs are at greater risk of producing it.
We suggest that multi-mechanistic analgesia, accomplished within either a single drug or a combination of drugs, is a logical approach that might result in a reduced development of OIH.
阿片类药物诱发痛觉过敏（OIH）的现象，即由于用于治疗疼痛的阿片类药物而导致的疼痛敏感性增加，在动物模型中得到了很好的证实，人们担心它也会发生在患者身上。我们的目的是简要总结 OIH 的基础科学和临床证据，作为考虑使用多机制镇痛方法的可能益处的背景。
OIH 的发生机制尚不清楚，甚至为什么会发生也不清楚；大概，它是一种适应性反应的一部分。但是 OIH 的发展带来了严重的治疗困境。OIH 与耐受性不同，后者表现为镇痛效果降低，因为耐受性可以通过谨慎和监测的增加阿片类药物剂量来解决，但 OIH 需要减少阿片类药物剂量来治疗。因此，避免诱导 OIH 非常重要。目前，尚不清楚哪些患者更容易发生 OIH，或者哪些药物更容易产生 OIH。
我们建议，多机制镇痛，无论是通过单一药物还是药物组合来实现，都是一种合理的方法，可能会减少 OIH 的发生。
