Opioid-induced hyperalgesia in community-dwelling adults with chronic pain

• Published in: Pain (Amsterdam) Vol. 156; no. 6; pp. 1145 - 1152
• Main Authors: Hooten, W. Michael, Lamer, Tim J., Twyner, Channing
• Format: Journal Article
• Language: English
• Published: United States International Association for the Study of Pain 01-06-2015
• Subjects: Adult; Analgesics, Opioid - adverse effects; Catastrophization - etiology; Chronic Pain - complications; Chronic Pain - drug therapy; Chronic Pain - psychology; Cohort Studies; Depression - etiology; Female; Humans; Hyperalgesia - chemically induced; Male; Middle Aged; Pain Measurement; Pain Threshold - drug effects; Residence Characteristics
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1097/j.pain.0000000000000170

The hyperalgesic effects of long-term opioid use in community-dwelling adults with chronic pain have not been widely reported. Therefore, the primary aim of this study was to determine the associations between opioid use and heat pain (HP) perception in a sample of community-dwelling adults with chronic pain. The study cohort involved 187 adults (85 opioid and 102 nonopioid) with chronic pain consecutively admitted to an outpatient interdisciplinary pain treatment program. Heat pain perception was assessed using a validated quantitative sensory test method of levels. An effect of opioid use was observed for nonstandardized (P = 0.004) and standardized (P = 0.005) values of HP 5-0.5 in which values of the opioid group were lower (more hyperalgesic) compared with those of the nonopioid group. HP 5-0.5 is a measure of the slope of the line connecting HP 0.5 (HP threshold) and HP 5 (intermediate measure of HP tolerance). In univariable (P = 0.019) and multiple variable (P = 0.003) linear regression analyses (adjusted for age, sex, body mass index, work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower (more hyperalgesic) nonstandardized values of HP 5-0.5. Similarly, in univariable (P = 0.004) and multiple variable (P = 0.011) linear regression analyses (adjusted for work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower standardized values of HP 5-0.5. In this sample of community-dwelling adults, these observations suggest that long-term opioid use was associated with hyperalgesia independent of other clinical factors known to influence HP perception.