Bannister Kirsty
Pharmacology of Pain Group, Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.
Curr Opin Support Palliat Care. 2015 Jun;9(2):116-21. doi: 10.1097/SPC.0000000000000137.
Patients receiving chronic opioid treatment who develop paradoxical pain sensations, as well as worsening existing pain, can be diagnosed as suffering from opioid-induced hyperalgesia (OIH). As the worldwide population expands so too does the proportion of patients who experience pain that requires a strong opioid. Recognizing the symptoms of OIH and optimizing the use of morphine in the hospital setting is imperative. This review focuses on clinical data relating to evidence of OIH at the bedside and the novel techniques employed by healthcare providers in order to improve the heightened pain sensations experienced by susceptible patients.
An increasing number of randomized prospective controlled trials report worsening patient pain following high-dose opioid treatment. Patient case reports support the premise that OIH is a clinical reality. According to recent literature, for those individuals who develop paradoxical pain sensations upon chronic opioid therapy, the most successful course of action involves a multidisciplinary attack that usually comprises early diagnosis, opioid switching and adjunct therapies.
Looking to the future, improved clinician-patient communication, advanced diagnostic techniques and a refinement of prescribed adjunct pharmacotherapies will offer the most successful multimodal pain management approach to the problem of OIH.
接受慢性阿片类药物治疗的患者若出现反常性疼痛感觉以及现有疼痛加剧，可被诊断为患有阿片类药物诱导的痛觉过敏（OIH）。随着全球人口增长，需要强效阿片类药物治疗疼痛的患者比例也在增加。识别OIH的症状并在医院环境中优化吗啡的使用至关重要。本综述重点关注与床边OIH证据相关的临床数据以及医疗服务提供者采用的新技术，以改善易感患者所经历的疼痛加剧情况。
越来越多的随机前瞻性对照试验报告称，高剂量阿片类药物治疗后患者疼痛加剧。患者病例报告支持OIH是临床现实这一前提。根据最近的文献，对于那些在慢性阿片类药物治疗后出现反常性疼痛感觉的个体，最成功的行动方案包括多学科治疗，通常包括早期诊断、阿片类药物转换和辅助治疗。
展望未来，改善医患沟通、先进的诊断技术以及优化处方辅助药物治疗将为OIH问题提供最成功的多模式疼痛管理方法。
