domingo, 31 de enero de 2016

Más de hiperalgesia opioide / More on opioid hyperalgesia

Enero 27, 2016. No. 2219


Hiperalgesia inducida por opioides: Un dilema de diagnóstico
Opioid-Induced Hyperalgesia: A Diagnostic Dilemma.
J Pain Palliat Care Pharmacother. 2015 Dec;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.
KEYWORDS: acute or chronic pain; cancer pain; hyperalgesia; multimodal pain management; opioid; opioid-induced androgen deficiency; physical dependence; tolerance
Uso de dosis muy bajas de metadona en el manejo paliativo del dolor y prevención de hiperalgesia opioide
The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia.
J Palliat Med. 2013 Jun;16(6):616-22. doi: 10.1089/jpm.2012.0612. Epub 2013 Apr 4.
CONCLUSION: The use of very-low-dose methadone in conjunction with adjuvant haloperidol resulted in excellent pain control without dose escalation or opioid-induced hyperalgesia, for both cancer and noncancer diseases. We conclude that low-dose methadone should be part of first-line treatment in palliative pain management.
Hiperalgesia inducida por opioides en anestesia
Opioid induced hyperalgesia in anesthetic settings.
Korean J Anesthesiol. 2014 Nov;67(5):299-304. doi: 10.4097/kjae.2014.67.5.299. Epub 2014 Nov 26
Pain is difficult to investigate and difficult to treat, in part, because of problems in quantification and assessment. The use of opioids, combined with classic anesthetics to maintain hemodynamic stability by controlling responses to intraoperative painful events has gained significant popularity in the anesthetic field. However, several side effects profiles concerning perioperative use of opioid have been published. Over the past two decades, many concerns have arisen with respect to opioid-induced hyperalgesia (OIH), which is the paradoxical effect wherein opioid usage may decrease pain thresholds and increase atypical pain unrelated to the original, preexisting pain. This brief review focuses on the evidence, mechanisms, and modulatory and pharmacologic management of OIH in order to elaborate on the clinical implication of OIH.
KEYWORDS: Hyperalgesia; Opioid Analgesics; Postoperative pain

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