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      Comparison of pain models to detect opioid-induced hyperalgesia

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          Abstract

          Objective

          Chronic opioid therapy may be associated with hyperalgesia. Our objective was to determine if opioid-induced hyperalgesia detection sensitivity is dependent on the stimulus used to detect it.

          Methods

          This open design study compared the detection of hyperalgesia in opioid-dependent subjects (n = 16) and healthy control subjects (n = 16) using the following pain stimuli: cold pain, electrical stimulation, mechanical pressure, and ischemic pain. The opioid-dependent subjects were maintained on either methadone (n = 8) or buprenorphine (n = 8) for at least 3 months. None of the controls was dependent on opioids or other drugs of abuse.

          Results

          The opioid-dependent subjects were markedly more sensitive than controls to the cold pain test. Compared with the control group, the hazard ratio for ceasing the test due to intolerable pain was 7.7 (95% confidence interval [CI] 2.6–23.3) in the buprenorphine group and 4.5 (95% CI 1.7–15.6) in the methadone group, with similar data for the cold pain threshold. Of the remaining tests, there were differences only for the electrical pain threshold between treatment groups, with the geometric mean threshold in the buprenorphine group being 1.5 (95% CI 1.1–1.9)-fold higher (ie, less sensitive) than that of the controls; the geometric mean for the methadone group was 1.3 (95% CI 1.04–1.7)-fold higher than that of the controls. There were no significant differences between buprenorphine and methadone patients in test responses. Women were more sensitive to the cold pain (hazard ratio for tolerance, 3.1 [95% CI 1.4–7.3]) and ischemic tests (hazard ratio for tolerance, 2.7 [95% CI 1.2–6.1]). There were significant correlations between cold and ischemic tolerances (r = 0.50; P = 0.003) and between electrical and mechanical pain tolerances (r = 0.52; P = 0.002).

          Conclusion

          These findings indicate that cold pain is the most suitable of the methods tested to detect opioid-induced hyperalgesia. This is consistent with its sensitivity to detect opioid analgesia.

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          Author and article information

          Journal
          J Pain Res
          J Pain Res
          Journal of Pain Research
          Dove Medical Press
          1178-7090
          2012
          27 April 2012
          : 5
          : 99-106
          Affiliations
          [1 ]Discipline of Pharmacology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
          [2 ]Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
          [3 ]Pain and Anesthesia Research Clinic, Royal Adelaide Hospital, Adelaide, South Australia, Australia
          [4 ]Pharmacy School, University of South Australia, Adelaide, South Australia, Australia
          Author notes
          Correspondence: Paul Rolan, Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, South Australia, 5005, Australia, Tel +61 8 83134102, Fax +61 8 82240685, Email paul.rolan@ 123456adelaide.edu.au
          Article
          jpr-5-099
          10.2147/JPR.S27738
          3346067
          22570562
          © 2012 Krishnan et al, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Original Research

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