Palliative Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Palliative Medicine, Sir Michael Sobell House Hospice, Oxford, UK.
BMJ Support Palliat Care. 2020 Sep;10(3):310-311. doi: 10.1136/bmjspcare-2019-001901. Epub 2019 Aug 29.
There remains uncertainty regarding the existence, mechanism and frequency of opioid-induced hyperalgesia (OIH). Literature to date has been dominated by the phenanthrene opioids, fentanyl and remifentanil. This case draws attention to alfentanil as an additional contributor. In this report, suspected OIH and subsequent reduction in opioid dose led to a dramatic diminution of pain. Omission of such a differential may have led to detrimental consequences. Underlying dementia heightened his vulnerability and illustrates the necessity of clinical expertise in the diagnosis and management of OIH, particularly when diagnostic criteria are lacking. The case demonstrates the need to include OIH as a plausible differential diagnosis in escalating pain where opioid tolerance, disease progression and non-opioid sensitive pain are excluded.
关于阿片类药物引起的痛觉过敏（OIH）的存在、机制和频率仍存在不确定性。迄今为止，文献主要集中在菲类阿片类药物芬太尼和瑞芬太尼上。本病例提请注意阿芬太尼是另一个促成因素。在本报告中，怀疑 OIH 并随后减少阿片类药物剂量导致疼痛明显减轻。如果忽略这种差异，可能会导致不良后果。潜在的痴呆症增加了他的脆弱性，并说明了在诊断和管理 OIH 时临床专业知识的必要性，特别是在缺乏诊断标准的情况下。该病例表明，在排除阿片类药物耐受、疾病进展和非阿片类药物敏感疼痛后，需要将 OIH 作为进行性疼痛的一个合理鉴别诊断。
