opioid induced hyperalgesia — oregon health science 阿片类药物诱导的痛觉过敏—俄勒冈健康与科学.pptVIP

* * * * * * * * * * * * * * * * Phenantrene ring Barriers to Treatment Clinicians often do not know about, recognize, or understand OIH Family/ patients understanding: How can my Morphine do harm? Both groups need education Management of HD Pain controlled/ mild: ↓ opioid dose Uncontrolled pain: ↓ dose + adjuvant OR rotate to non-phenantrene opioid Benzodiazapines Fluids Educate Davis M, Walsh D Bottom Line Future of pain control will be greatly influenced by this area of research Peripheral nerves, spinal cord CNS all involved in OIH Chronic pain could be worsened by acute and ongoing opioid therapy Bottom Line (cont’d) For Patients with resistant/ escalating pain, hyperalgesia should be considered OIH (HD) treat with decreased opioid dose or rotation to another opioid I hope this has given some insight into some of the challenges in treating pain I hope this helps you recognize OIH (HD) Questions to ponder Opioid tolerance hyperalgesia linked? Worsening chronic non-malignant pain? Are there genetic differences that cause OIH MW HD? What is on horizon to help HD OIH? Ketamine like medication? Bibliography Angst MA, Clark JD: Opioid induced hyperalgesia. Anesth 2006; 104: 570-87 Mercandante S, Ferrera P, et al: Hyperalgesia: an emerging Iatrogenic Syndrome. J Pain and Sympt Management 2003; 2: 769-775 Davis MP, Shaiova LA, Angst MS: When opioids cause pain. 2007; 25: 4497-4498 Chang G, Chen L, Mao J: Opioid tolerance and hyperalgesia. 2007; 91: 199-211 Bibliography Ballantyne JC, et all: Opioid Induced Hyperalgesia. Pain: Clinical Updates 2008; 16: 1-4 Celerier E, Rivat C, et al: Long-lasting Hyperalgesia Induced by Fentanyl in Rats. Anesth 2001; 92: 465-72 Celerier E, Laulin JP, et al: Progressive Enhancement of Delayed Hyperalgesia Induced by Repeated Heroin Administration: a Sensitization Process. J Neurosc 2001; 21: 4074-80 Chu LF, Clark DJ, et al: Opioid Tolerance and Hyperalgesia in Chronic Pain Patients after one