Widespread Pain

Opioid Induced Hyperalgesia

Definition

Opioid induced hyperalgesia is defined as an increase in pain due to the patient's use of opioids.

Aetiology

The aetiology of opioid induced hyperalgesia is unknown, but is possibly related to an imbalance in the central nociceptive and proprioceptive systems.

Signs and symptoms

Despite an increasing dose of opioids, the patient's pain is not reduced but rather increases, resulting in a generalised pain pattern.

Diagnostics

Physical Examination

A general physical examination and extensive neurological examination are very important in order to exclude other causes. Touching patients with allodynia and hyperalgesia is painful.

Additional Somatic Diagnostics

  • QST
  • Skin biopsy

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

  • Reducing or stopping opioids and/or rotation to an NMDA-receptor antagonist (methadone).
  • COX-2 inhibitors

Somatic Treatment