Opioid-Induced Hyperalgesia and Tolerance
Opioid-Induced Hyperalgesia and Tolerance
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DOI：
10.1097/mjt.0b013e3181ed83a0
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发表时间：
2010-09-01
影响因子：
4.2
通讯作者：
Bekhit, Mary Hanna
中科院分区：
文献类型：
--
作者：
Bekhit, Mary Hanna
我们都无数次遇到过以下的麻醉后护理困境。作为麻醉后护理病房的主治医师，麻醉师经常会遇到以下的临床情况：“他在手术室内需要500毫克芬太尼进行脚趾截肢，并接受了20毫克吗啡，他仍然抱怨剧痛....你觉得他需要更多的吗啡吗？”阿片类药物作为治疗中度至重度手术疼痛和慢性疼痛的一线药物。然而，它们的使用实际上可能会混淆术后的临床图像，因为与直觉相反的阿片类药物暴露实际上可能会引发夸大的痛觉。当评估病人经历术后或慢性疼痛时，应该想到几个问题。首先，该患者是否出现阿片类药物治疗引起的耐受性或痛觉过敏？第二，两种病因的治疗方法不同吗？第三，在神经解剖学和分子/化学水平上，这两个过程背后的潜在机制是什么？第四，最近关于阿片类药物引起的痛觉过敏的文献如何影响先前接受的先发制人镇痛的观点？第五，阿片类药物引起的痛觉过敏有哪些治疗方法？最重要的是，第六，如何预防阿片类药物引起的痛觉过敏？在这篇文献综述中，我们旨在解决这些问题，并希望改变目前对阿片类药物围手术期和慢性疼痛状态的认知和管理。
We have all encountered the following postanesthesia care unit dilemma a myriad of times. As the attending covering the postanesthesia care unit, the anesthesiologist will be confronted not infrequently with the following clinical scenario: "He needed 500 mu g fentanyl in the operating room for a toe amputation and has received 20 mg morphine, and he's still complaining of severe pain .... Do you think he may need more morphine?" Opiates do prevail as first-line therapy for moderate to severe surgical and chronic pain states. However, their use may actually confound the clinical picture postoperatively, because opiate exposure counterintuitively may actually trigger exaggerated pain sensation. When assessing a patient experiencing exaggerated postoperative or chronic pain, several questions should come to mind. First, is this patient experiencing tolerance or hyperalgesia induced by opiate therapy? Second, does the management differ for the two etiologies? Third, what underlying mechanisms, both at the neuroanatomic and molecular/chemical levels, underlie the two processes? Fourth, how does the recent literature on opiate-induced hyperalgesia influence previously accepted views of pre-emptive analgesia? Fifth, what treatment modalities exist for opiate-induced hyperalgesia? Most importantly, sixth, how can opiate-induced hyperalgesia be prevented? In this literature review, we aim to address these questions and to hopefully change the current perception and management of perioperative and chronic pain states with opiates.