Opioid-induced hyperalgesia: A diagnostic dilemma

Veronica P. Carullo, Ingrid Fitz-James, Ellise S. Delphin

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Opioids are utilized frequently for the treatment of moderate to severe acute pain in the perioperative setting, as well as in the treatment of cancer-related pain. When prescribing chronic opioid therapy to patients with chronic pain, it is crucial for the practitioner to be aware not only of the issues of tolerance and withdrawal, but also to have knowledge of the possibility for opioid-induced hyperalgesia (OIH). An understanding of the differences between tolerance and OIH when escalating opioid therapy allows the titration of opioid as well as nonopioid analgesics in order to obtain maximum control of both chronic and acute pain. A case study is described to highlight the importance of judicious utilization of opioids in the treatment of cancer-related pain. In this case, high-dose opioid therapy did not improve chronic pain and contributed to a hyperalgesic state in which a young man experienced severe intractable pain postoperatively after two routine thoracotomies, despite aggressive pharmacologic measures to manage his perioperative pain. Furthermore, it illustrates the potential advantages of opioid rotation to methadone when OIH is suspected.

Original languageEnglish (US)
Pages (from-to)378-384
Number of pages7
JournalJournal of Pain and Palliative Care Pharmacotherapy
Issue number4
StatePublished - Oct 2 2015


  • acute or chronic pain
  • cancer pain
  • hyperalgesia
  • multimodal pain management
  • opioid
  • opioidinduced androgen deficiency
  • physical dependence
  • tolerance

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pharmacology (medical)


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