A 35-Year-Old Opioid-Tolerant Patient with Uncontrolled Pain After Surgery
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In 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) advocated for pain to be the “fifth vital sign” and, ever since, the use of opioids for pain management has increased exponentially each year (Gulur, et al., Pain Physician. 17:E503–7, 2014). Mistakenly, opioids are thought of as the first line of treatment for pain. The United States appears to be the main consumer of opioids accounting for 56% of morphine and 81% of oxycodone usage globally (International Narcotics Control Board. Narcotic drugs technical reports. Estimated world requirements for 2011. https://www.incb.org. Accessed 24 May 2018). There is growing evidence that opioids may have a negative impact on pain, especially postoperative pain. Studies show that chronic opioid exposure can lead to opioid tolerance or opioid-induced hyperalgesia (OIH)—two distinct phenomena that are directly related to opioid therapy and are often difficult to control. Clinical differentiation between these two phenomena can be challenging. Anesthetic technique can influence the development of opioid tolerance and OIH. A multimodal approach is recommended and includes preemptive analgesia, intraoperative infusion therapy, consideration of regional techniques, and maximizing the use of non-opioid medications.
KeywordsPostsurgical pain Opioids-induced tolerance Opioids-induced hyperalgesia Multimodal analgesia Regional analgesia Infusion therapy
- 2.International Narcotics Control Board. Narcotic drugs technical reports. Estimated world requirements for 2011. https://www.incb.org. Accessed 24 May 2018.
- 3.Food and Drug Administration. Extended-release (ER) and long-acting (LA) opioid analgesics risk evaluation and mitigation strategy (REMS). FDA REMS modification. 2015;10.Google Scholar
- 15.NCI Thesaurus [Internet]. Ncit.nci.nih.gov. 2018 [cited 24 May 2018]. Available from: https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=NCI_Thesaurus&code=C198.
- 19.NCI Thesaurus [Internet]. Ncit.nci.nih.gov. 2018 [cited 24 May 2018]. Available from: https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&version=18.03d&ns=ncit&code=C614&key=517506826&b=1&n=null.
- 21.Elmofty D. Opioid-induced hyperalgesia, tolerance and chronic postsurgical pain; a dilemma complicating postoperative pain management. In: Anitescu A, editor. Pain management review: a problem-based learning approach. New York, NY, USA: Oxford University Press. p. 303–9.Google Scholar