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Original article
Pressure Pain Sensitivity in Patients With Suspected Opioid-Induced Hyperalgesia
  1. Ronald A. Wasserman, MD,
  2. Afton L. Hassett, PsyD,
  3. Steven E. Harte, PhD,
  4. Jenna Goesling, PhD,
  5. Herbert L. Malinoff, MD,
  6. Daniel W. Berland, MD,
  7. Jennifer Zollars, BA,
  8. Stephanie E. Moser, PhD and
  9. Chad M. Brummett, MD
  1. From the Department of Anesthesiology, Division of Pain Research and the Back and Pain Center, University of Michigan, Ann Arbor, MI
  1. Address correspondence to: Ronald A. Wasserman, MD, University of Michigan Back and Pain Center, Burlington Bldg 1, Floor 1, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108 (e-mail: ronaldw{at}med.umich.edu).

Abstract

Background and Objectives This study was designed to test whether a brief quantitative sensory testing assessment could be used to detect hyperalgesia in patients with suspected opioid-induced hyperalgesia (OIH).

Methods Twenty patients on long-term opioid therapy with suspected OIH were recruited along with 20 healthy controls. Pressure pain threshold, Pain50, a measure of intermediate suprathreshold pressure pain sensitivity, and tolerance levels were evaluated. As a secondary outcome, changes in pressure pain sensitivity after intravenous administration of placebo (saline) and fentanyl (1.5 μg/kg) were assessed.

Results There were no significant differences in pain measures between healthy controls and patients. However, there was an association between higher doses of opioids and having a lower pain tolerance (r = −0.46, P = 0.041) and lower Pain50 (r = −0.46, P = 0.044), which was consistent with the hypothesis. Patients on more than 100 mg oral morphine equivalents displayed decreased pressure pain tolerance compared with patients taking less than 100 mg oral morphine equivalents (P = 0.042). In addition, male patients showed a hyperalgesic response to fentanyl administration, which was significant for the Pain50 measure (P = 0.002).

Conclusions Whereas there were no differences between patients suspected of having OIH and the healthy controls, the finding that higher doses of opioids were associated with more sensitivity suggests that dose might be an important factor in the development of hyperalgesia. In addition, male patients demonstrated a hyperalgesic response after a bolus of fentanyl. Future studies are needed to develop better diagnostics for detecting hyperalgesia in the clinical setting.

https://doi.org/10.1097/AAP.0000000000000315

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    Footnotes

    • Dr Brummett receives research funding from Neuros Medical, Inc (Willoughby Hills, Ohio) and is a consultant for Tonix Pharmaceuticals (New York, New York). Dr Hassett has received research funding from and has been a consultant for Bristol-Myers Squibb (New York, New York) and Pfizer (New York, New York). Dr Harte has received research funding from Cerephex (Palo Alto, California), Forest Laboratories (New York, New York), and Merck (White House Station, New Jersey) and serves as a consultant for Pfizer (New York, New York), Analgesic Solutions (Natick, Massachusetts), Regeneron (Tarrytown, New York), and deCode Genetics (Reykjavik, Iceland). Dr Harte is coinventor of the Multimodal Automated Sensory Testing device used in this study. The other authors declare no conflict of interest.

      This study was supported by a Michigan Institute for Clinical and Health Research grant (2UL1TR000433).

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