AI Article Synopsis
- Opioid-induced hyperalgesia (OIH) is an unexpected change in pain sensitivity seen in patients using opioids for chronic pain, prompting this study to compare pain sensitivity in those treated with opioids versus non-opioid analgesics.
- Pain sensitivity to cold was tested in 73 opioid patients and 37 non-opioid patients, revealing no significant differences in cold pain measures but a notably stronger diffuse noxious inhibitory control (DNIC) in the non-opioid group.
- The study concluded that while oral opioids do not increase sensitivity to cold pain, they appear to negatively affect pain modulation compared to non-opioid treatments, emphasizing the need for advanced testing to better understand OIH.
Article Abstract
Opioids can elicit unexpected changes in pain sensitivity, known as opioid-induced hyperalgesia (OIH). The aim of this study was to explore whether OIH exists in patients with chronic pain treated with oral opioids (OP) versus non-opioid (NOP) analgesics. The sensitivity to cold pain and the magnitude of diffuse noxious inhibitory control (DNIC) were evaluated in 73 OP and 37 NOP treated patients. Pain threshold, intensity and tolerance in response to the cold pressor (1 degrees C) were measured. DNIC was tested by co-administrating conditioned heat stimulation (47 degrees C) to the left forearm and a conditioning stimulation of 12 degrees C for 30s to the right hand. The results showed no differences between the two groups in any of the cold pain measures. In contrast, the magnitude of DNIC was significantly larger in the NOP than in the OP treated patients (p=0.003). A gender based analysis showed a significant difference in DNIC between OP and NOP treated men only. However, a mixed model ANOVA demonstrated a significant effect of treatment (OP versus NOP) (F=5.928, p=0.017) rather than gender on DNIC. A regression analysis showed that opioid dosage and treatment duration had a significant negative effect on the magnitude of DNIC in OP treated men (beta=-2.175, p=0.036 and beta=-2.061, p=0.047, respectively). In conclusion, oral opioids usage for the treatment of chronic pain does not result in abnormal sensitivity to cold pain, but seems to alter pain modulation. The use of 'advanced' psychophysics tests such as evaluation of DNIC can help understanding the phenomenon of OIH.
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| http://dx.doi.org/10.1016/j.pain.2008.05.015 | DOI Listing |
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