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Opioïdgeïnduceerde hyperalgesie in de palliatieve zorg

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Inzichten in de palliatieve zorg

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In dit hoofdstuk wordt de situatie beschreven waarin ten gevolge van het geven van opioïden pijnklachten toe- in plaats van afnemen. Hoewel dit negatieve effect van opioïden al in de negentiende eeuw bekend was, zijn de oorzaken hiervan pas de afgelopen decennia duidelijk geworden. Het toedienen van opioïden kan leiden tot een zodanige verandering in de pijnregistrerende en -regulerende systemen in het perifere en centrale zenuwstelsel dat er geen remming meer optreedt van nociceptieve input, maar dat de patiënt een steeds verder escalerende pijn ervaart. Het preklinisch en klinisch onderzoek aangaande de oorzaken van het optreden van deze ernstige bijwerking van opioïden worden uitgelegd. De verschillende farmacologische mechanismen die mede verantwoordelijk zijn voor het ontstaan van hyperalgesie worden verklaard, te weten de rol van de N-methyl-D-aspartaat receptor en dynorfine. Uitgaande van deze oorzaken van hyperalgesie, worden de vereiste aanpassingen van het analgetisch beleid beschreven, waarin methadon en buprenorfine een voorname rol vervullen.

anesthesioloog-pijnspecialist, FIPP

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Authors and Affiliations

  1. Afdeling Pijn en Palliatieve geneeskunde, Radboudumc, Nijmegen, The Netherlands

    Kees (T.C.) Besse & Kris (K.C.P.) Vissers

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  1. Kees (T.C.) Besse
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  2. Kris (K.C.P.) Vissers
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Editor information

Editors and Affiliations

  1. Huisartsgeneeskunde, UMC Groningen, Groningen, The Netherlands

    A.J. Berendsen

  2. UMC St Radboud, Nijmegen, The Netherlands

    F.M. van Soest

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© 2014 Bohn Stafleu van Loghum

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Besse, K., Vissers, K. (2014). Opioïdgeïnduceerde hyperalgesie in de palliatieve zorg. In: Berendsen, A., van Soest, F. (eds) Inzichten in de palliatieve zorg. Bohn Stafleu van Loghum, Houten. https://doi.org/10.1007/978-90-368-0826-2_11

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  • DOI: https://doi.org/10.1007/978-90-368-0826-2_11

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  • Publisher Name: Bohn Stafleu van Loghum, Houten

  • Print ISBN: 978-90-368-0825-5

  • Online ISBN: 978-90-368-0826-2

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