Carullo Veronica, Fitz-James Ingrid, Delphin Ellise
J Pain Palliat Care Pharmacother. 2015;29(4):378-84. doi: 10.3109/15360288.2015.1082006. Epub 2015 Nov 2.
Opioids are utilized frequently for the treatment of moderate to severe acute pain in the perioperative setting, as well as in the treatment of cancer-related pain. When prescribing chronic opioid therapy to patients with chronic pain, it is crucial for the practitioner to be aware not only of the issues of tolerance and withdrawal, but also to have knowledge of the possibility for opioid-induced hyperalgesia (OIH). An understanding of the differences between tolerance and OIH when escalating opioid therapy allows the titration of opioid as well as nonopioid analgesics in order to obtain maximum control of both chronic and acute pain. A case study is described to highlight the importance of judicious utilization of opioids in the treatment of cancer-related pain. In this case, high-dose opioid therapy did not improve chronic pain and contributed to a hyperalgesic state in which a young man experienced severe intractable pain postoperatively after two routine thoracotomies, despite aggressive pharmacologic measures to manage his perioperative pain. Furthermore, it illustrates the potential advantages of opioid rotation to methadone when OIH is suspected.
阿片类药物常用于围手术期治疗中度至重度急性疼痛，以及治疗癌症相关疼痛。在为慢性疼痛患者开慢性阿片类药物治疗处方时，从业者不仅要了解耐受性和戒断问题，还要知晓阿片类药物诱导的痛觉过敏（OIH）的可能性，这至关重要。在增加阿片类药物治疗时，了解耐受性和OIH之间的差异有助于调整阿片类药物以及非阿片类镇痛药的剂量，从而最大程度地控制慢性和急性疼痛。本文描述了一个病例研究，以强调在治疗癌症相关疼痛时合理使用阿片类药物的重要性。在该病例中，高剂量阿片类药物治疗并未改善慢性疼痛，反而导致了痛觉过敏状态，一名年轻男子在两次常规开胸手术后术后经历了严重的顽固性疼痛，尽管采取了积极的药物措施来管理其围手术期疼痛。此外，该病例还说明了在怀疑存在OIH时将阿片类药物换成美沙酮的潜在优势。
