Podcast 668: Opioid-Induced Hyperalgesia

Emergency Medical Minute

Contributor: Donald Stader, MD

Educational Pearls:

• Opioids target kappa and NMDA receptors that can lead to central nervous system sensitization and therefore increased pain
• For patients with opioid-induced hyperalgesia (OIH), oral ketamine (25-50 mg) can be used to treat their pain as it targets the NMDA receptor
• Other treatments is IV magnesium, NSAIDs, tylenol, and clonidine
• Buprenorphine and methadone are options for chronic pain management in the setting of OIH

References

Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145-161.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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