Opioid-induced hyperalgesia (OIH) is a phenomenon whereby opioids increase patients’ pain sensitivity, complicating their use in analgesia. We explored practitioners’ attitudes towards, and knowledge concerning diagnosis, risk factors, and treatment of OIH.
We administered an 18-item cross-sectional survey to 850 clinicians that managed chronic pain with opioid therapy.
The survey response rate was 37% (318 of 850). Most respondents (240 of 318, 76%) reported they had observed patients with OIH in their practice, of which 38% (84 of 222) reported OIH affected >5% of their chronic pain patients. The majority (133 of 222, 60%) indicated that OIH could result from any dose of opioid therapy. The most commonly endorsed chronic pain conditions associated with development of OIH were fibromyalgia (109 of 216, 51%) and low back pain (91 of 216, 42%), while 42% (91 of 216) indicated that no individual chronic pain condition was associated with greater risk of OIH. The most commonly endorsed opioids associated with development of OIH were oxycodone (94 of 216, 44%), fentanyl (86 of 216, 40%), and morphine (84 of 216, 39%); 27% (59 of 216) endorsed that no specific opioid was more likely to result in OIH. Respondents commonly managed OIH by opioid dose reduction (147 of 216, 68%), administering a non-opioid adjuvant (133 of 216, 62%), or discontinuing opioids (95 of 216, 44%).
Most clinicians agreed that OIH is a complication of opioid therapy, but were divided regarding the prevalence of OIH, etiological factors, and optimal management.