Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back pain
- PMID: 22704854
- DOI: 10.1016/j.pain.2012.02.028
Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back pain
Abstract
Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief. Analgesic tolerance, and more recently opioid-induced hyperalgesia, have been invoked to explain such declines in opioid effectiveness over time. Because both phenomena result in inadequate analgesia, they are difficult to distinguish in a clinical setting. Patients with otherwise uncomplicated low-back pain were titrated to comfort or dose-limiting side effects in a prospective, randomized, double-blind, placebo-controlled clinical trial using sustained-release morphine or weight-matched placebo capsules for 1 month. A total of 103 patients completed the study, with an average end titration dose of 78 mg morphine/d. After 1 month, the morphine-treated patients developed tolerance to the analgesic effects of remifentanil, but did not develop opioid-induced hyperalgesia. On average, these patients experienced a 42% reduction in analgesic potency. The morphine-treated patients experienced clinically relevant improvements in pain relief, as shown by a 44% reduction in average visual analogue scale pain levels and a 31% improvement in functional ability. The differences in visual analogue scale pain levels (P = .003) and self-reported disability (P = .03) between both treatment groups were statistically significant. After 1 month of oral morphine therapy, patients with chronic low-back pain developed tolerance but not opioid-induced hyperalgesia. Improvements in pain and functional ability were observed.
Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Comment in
-
Tolerance and opioid-induced hyperalgesia. Is a divorce imminent?Pain. 2012 Aug;153(8):1547-1548. doi: 10.1016/j.pain.2012.05.002. Epub 2012 May 17. Pain. 2012. PMID: 22608577 No abstract available.
Similar articles
-
Evolution of Analgesic Tolerance and Opioid-Induced Hyperalgesia Over 6 Months: Double-Blind Randomized Trial Incorporating Experimental Pain Models.J Pain. 2020 Sep-Oct;21(9-10):1031-1046. doi: 10.1016/j.jpain.2020.01.005. Epub 2020 Feb 1. J Pain. 2020. PMID: 32006699 Clinical Trial.
-
Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: a preliminary prospective study.J Pain. 2006 Jan;7(1):43-8. doi: 10.1016/j.jpain.2005.08.001. J Pain. 2006. PMID: 16414554 Clinical Trial.
-
Tolerance and opioid-induced hyperalgesia. Is a divorce imminent?Pain. 2012 Aug;153(8):1547-1548. doi: 10.1016/j.pain.2012.05.002. Epub 2012 May 17. Pain. 2012. PMID: 22608577 No abstract available.
-
Pain management in the opioid-dependent patient.Curr Psychiatry Rep. 2001 Dec;3(6):489-96. doi: 10.1007/s11920-001-0043-9. Curr Psychiatry Rep. 2001. PMID: 11707163 Review.
-
Chronic Cancer Pain: Opioids within Tumor Microenvironment Affect Neuroinflammation, Tumor and Pain Evolution.Cancers (Basel). 2022 Apr 30;14(9):2253. doi: 10.3390/cancers14092253. Cancers (Basel). 2022. PMID: 35565382 Free PMC article. Review.
Cited by
-
Psycho-physiological response to pain among individuals with comorbid pain and opioid use disorder: Implications for patients with prolonged abstinence.Am J Drug Alcohol Abuse. 2019;45(5):495-505. doi: 10.1080/00952990.2019.1620260. Epub 2019 Jun 27. Am J Drug Alcohol Abuse. 2019. PMID: 31246117 Free PMC article.
-
Differential Effects of a Novel Opioid Ligand UTA1003 on Antinociceptive Tolerance and Motor Behaviour.Pharmaceuticals (Basel). 2022 Jun 24;15(7):789. doi: 10.3390/ph15070789. Pharmaceuticals (Basel). 2022. PMID: 35890089 Free PMC article.
-
Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain: A Cross-Sectional Population Based Study.J Pain. 2018 Oct;19(10):1104-1112. doi: 10.1016/j.jpain.2018.04.004. Epub 2018 Apr 17. J Pain. 2018. PMID: 29678564 Free PMC article.
-
Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review.J Occup Rehabil. 2024 Jun;34(2):398-414. doi: 10.1007/s10926-023-10138-y. Epub 2023 Nov 7. J Occup Rehabil. 2024. PMID: 37934329 Free PMC article.
-
Opioid Receptors in Immune and Glial Cells-Implications for Pain Control.Front Immunol. 2020 Mar 4;11:300. doi: 10.3389/fimmu.2020.00300. eCollection 2020. Front Immunol. 2020. PMID: 32194554 Free PMC article. Review.
References
-
- Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104:570-587.
-
- Angst MS, Koppert W, Pahl I, Clark DJ, Schmelz M. Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain. 2003;106:49-57.
-
- Angst MS, Ramaswamy B, Riley ET, Stanski DR. Lumbar epidural morphine in humans and supraspinal analgesia to experimental heat pain. Anesthesiology. 2000;92:312-324.
-
- Beck A, Steer R, Carbin M. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77-100.
-
- Chia YY, Liu K, Wang JJ, Kuo MC, Ho ST. Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth. 1999;46:872-877.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical