Opioid-induced Hyperalgesia: A Qualitative Systematic Review
Open accessAbstract
Opioids are the cornerstone therapy for the treatment of moderate to severe pain. Although common concerns regarding the use of opioids include the potential for detrimental side effects, physical dependence, and addiction, accumulating evidence suggests that opioids may yet cause another problem, often referred to as opioid-induced hyperalgesia. Somewhat paradoxically, opioid therapy aiming at alleviating pain may render patients more sensitive to pain and potentially may aggravate their preexisting pain. This review provides a comprehensive summary of basic and clinical research concerning opioid-induced hyperalgesia, suggests a framework for organizing pertinent information, delineates the status quo of our knowledge, identifies potential clinical implications, and discusses future research directions.
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Withdrawal from chronic opioid self-administration produces hyperalgesia (lower pain thresholds) in humans and animal models.
“In humans and animal models, withdrawal from chronic opioid self-administration produces hyperalgesia (i.e., lower pain thresholds; Tilson et al., 1973;Angst and Clark, 2006).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Angst and Clark, 2006
The Human Studies section describes increased pain sensitivity during opioid withdrawal, and Small and Anecdotal Reports describes lower heat-pain tolerance in patients undergoing withdrawal. The Animal Studies section reports withdrawal hyperalgesia in rodents. These passages do not establish the claim specifically for chronic opioid self-administration; the animal studies described used administered opioids, and the human quantitative finding concerns pain tolerance rather than threshold. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe association between preoperative analgesia and poor postoperative pain control may be due to greater preoperative severity of pain, opioid-induced hyperalgesia and central or peripheral sensitisation to pre-existing nociception.
“This may be due to greater preoperative severity of pain, opioid-induced hyperalgesia and central or peripheral sensitisation to pre-existing nociception.23 69”
From Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis (2019) · cites this paper as [69]
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- Authors
- Angst, M. S., & Clark, J. D.
- Affiliations
- Stanford Medicine (US)
- VA Palo Alto Health Care System (US)
- ORCID
- Angst, Martin S.
- Venue
- Anesthesiology
- Published
- 2006-03-01
- Volume
- 104
- Issue
- 3
- Pages
- 570-587
- ISSN
- 0003-3022 (ISSN-L)
- OpenAlex
- W2005703418
- Cited by
- 1,188
- References
- 176
- Citations by year
- 2026: 30 · 2025: 34 · 2024: 26 · 2023: 37 · 2022: 34 · 2021: 49 · 2020: 98 · 2019: 55 · 2018: 59 · 2017: 45 · 2016: 62 · 2015: 80 · 2014: 84 · 2013: 77 · 2012: 83
- FWCI
- 10.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- opioid-induced hyperalgesia, opioids, pain sensitivity, analgesic side effects, chronic pain, opioid analgesia
- MeSH terms
- Analgesics, Opioid, Animals, Humans, Hyperalgesia, Opioid-Related Disorders
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