UMEM Educational Pearls

Category: Toxicology

Title: Opioid Induced Hyperalgesia

Keywords: Opioid, methadone, pain management, tolerance, analgesia (PubMed Search)

Posted: 6/6/2013 by Ellen Lemkin, MD, PharmD
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  • Opioid analgesia can actually INCREASE sensitivity to pain in some cases
  • The exact cause is unclear, but may be due to up-regulation of NDMA receptors in spinal cord dorsal horn neurons
  • Pain tends to be DIFFERENT and DIFFUSE from the underlying condition for which the narcotics were prescribed
  • Switching from shorter acting opiates to methadone may be effective, as it is a weak NDMA antagonist and has only partial cross tolerance with other opioids



Gussow, L. Toxicology Rounds. When Opioids Increase Pain. Emergency Medicine News Feb 2013. 35(2):6.