Dexmedetomidine Infusion for the Management of Opioid-Induced Hyperalgesia

Objective. Understanding the actions of opioids now encompasses pronociceptive as well as antinociceptive mechanisms. Opioid-induced hyperalgesia (OIH) refers to increased pain sensitivity due to high-dose or prolonged opioid exposure. It has become more important as patients with pain remain on opioids at higher doses for longer periods of time. One setting that highlights the dilemma of OIH is in the opioid-tolerant patient who is hospitalized for painful medical conditions or procedures and is unable to achieve adequate analgesia despite escalating opioid doses. This patient population often requires agents that act synergistically with opioids through different mechanisms to achieve analgesia. Dexmedetomidine is an alpha-2 adrenergic agonist that has been shown to synergize with opioids. Setting. Tertiary care hospital. Design. Case series. Method. Eleven hospitalized patients with OIH received dexmedetomidine to improve pain control and to lower opioid doses while avoiding opioid withdrawal. Results. A total of 64% (7/11) had substantial reductions in their baseline opioid doses at the time of discharge. Conclusions. The cases presented provide support for the clinical utility of alpha-2 agonists during opioid dose reduction in patients with OIH as well suggesting that they may contribute to the recovery of normal nociceptive and antinociceptive responses.