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Published in: CNS Drugs 6/2015

01-06-2015 | Review Article

Targeting Opioid-Induced Hyperalgesia in Clinical Treatment: Neurobiological Considerations

Authors: Caroline A. Arout, Ellen Edens, Ismene L. Petrakis, Mehmet Sofuoglu

Published in: CNS Drugs | Issue 6/2015

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Abstract

Opioid analgesics have become a cornerstone in the treatment of moderate to severe pain, resulting in a steady rise of opioid prescriptions. Subsequently, there has been a striking increase in the number of opioid-dependent individuals, opioid-related overdoses, and fatalities. Clinical use of opioids is further complicated by an increasingly deleterious profile of side effects beyond addiction, including tolerance and opioid-induced hyperalgesia (OIH), where OIH is defined as an increased sensitivity to already painful stimuli. This paradoxical state of increased nociception results from acute and long-term exposure to opioids, and appears to develop in a substantial subset of patients using opioids. Recently, there has been considerable interest in developing an efficacious treatment regimen for acute and chronic pain. However, there are currently no well-established treatments for OIH. Several substrates have emerged as potential modulators of OIH, including the N-methyl-D-aspartate and γ-aminobutyric acid receptors, and most notably, the innate neuroimmune system. This review summarizes the neurobiology of OIH in the context of clinical treatment; specifically, we review evidence for several pathways that show promise for the treatment of pain going forward, as prospective adjuvants to opioid analgesics. Overall, we suggest that this paradoxical state be considered an additional target of clinical treatment for chronic pain.
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Metadata
Title
Targeting Opioid-Induced Hyperalgesia in Clinical Treatment: Neurobiological Considerations
Authors
Caroline A. Arout
Ellen Edens
Ismene L. Petrakis
Mehmet Sofuoglu
Publication date
01-06-2015
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 6/2015
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-015-0255-x

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