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Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study
Peggy Compton RN, PhD,
 Steven Wang DMD, MD, MPH,
 Camron Fakhar MD, DDS,
 Stacey Secreto CCRC,
 Olivia Halabicky Arnold RN, PhD,
 Brian Ford MD, DMD, and
 Elliot V. Hersh DMD, MS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 1
Online Publication Date: Mar 28, 2023
DOI: 10.2344/anpr-69-03-03
Page Range: 9 – 16

poorer surgical outcomes in patients on opioid therapy is the phenomenon of opioid-induced hyperalgesia (OIH), 3 where ongoing opioid use results in increased sensitivity to pain. To evaluate the effects of OIH in a surgical patient population, pain responses and analgesic need of patients on opioid therapy vs those not on opioid therapy undergoing a similar surgical procedure were compared. It was hypothesized that relative to opioid-naïve patients, patients on opioid therapy for the management of chronic pain would have increased pain sensitivity prior to

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Effect of Preoperative Pain on Inferior Alveolar Nerve Block
Vivek Aggarwal MDS,
 Mamta Singla MDS,
 Arunajatesan Subbiya MDS,
 Paramasivam Vivekanandhan MDS,
 Vikram Sharma MDS,
 Ritu Sharma MDS,
 Venkatachalam Prakash MDS, and
 Nagarajan Geethapriya MDS
Article Category: Research Article
Volume/Issue: Volume 62: Issue 4
Online Publication Date: Jan 01, 2015
DOI: 10.2344/15-00019.1
Page Range: 135 – 139

of A-delta fibers. 1 , 4 , 7 The combined effect of these factors will cause hyperalgesia and allodynia. The presence of preoperative pain can affect the local anesthetic success rates and postoperative pain. Arqueta-Figueroa et al 8 evaluated the anesthetic efficacy of 4% articaine with 1 : 100,000 epinephrine in patients with symptomatic and asymptomatic irreversible pulpitis in mandibular posterior teeth. The success rate was significantly less in patients with symptomatic irreversible pulpitis (64.2%) than in patients with asymptomatic irreversible

; Linear correlation chart between Heft-Parker visual analog scale value of preoperative pain and intraoperative pain. (a) Center SGT (r = .2). (b) Center SB (r = .4).
Vivek Aggarwal,
 Mamta Singla,
 Arunajatesan Subbiya,
 Paramasivam Vivekanandhan,
 Vikram Sharma,
 Ritu Sharma,
 Venkatachalam Prakash, and
 Nagarajan Geethapriya

Linear correlation chart between Heft-Parker visual analog scale value of preoperative pain and intraoperative pain. (a) Center SGT (r = .2). (b) Center SB (r = .4).

Figure 1.; (a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients. Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.
Peggy Compton,
 Steven Wang,
 Camron Fakhar,
 Stacey Secreto,
 Olivia Halabicky Arnold,
 Brian Ford, and
 Elliot V. Hersh
Figure 1.
Figure 1.

(a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients.

Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.

Figure 2.; Seventy-Two–Hour Postoperative Pain Severity in Opioid-Using and Opioid-Naïve Patients. Increased perceived postoperative pain severity as measured with a visual analog scale (0 = no pain and 10 = severe pain; mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain.
Peggy Compton,
 Steven Wang,
 Camron Fakhar,
 Stacey Secreto,
 Olivia Halabicky Arnold,
 Brian Ford, and
 Elliot V. Hersh
Figure 2.
Figure 2.

Seventy-Two–Hour Postoperative Pain Severity in Opioid-Using and Opioid-Naïve Patients.

Increased perceived postoperative pain severity as measured with a visual analog scale (0 = no pain and 10 = severe pain; mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain.

Figure 3.; Analgesic Doses Taken During the First 72 Hours Postoperatively in Opioid-Using and Opioid-Naïve Patients. Patients with chronic pain on opioid therapy used more analgesics (mean, SD) during the first 72 hours postoperatively vs opioid-naïve patients without chronic pain.
Peggy Compton,
 Steven Wang,
 Camron Fakhar,
 Stacey Secreto,
 Olivia Halabicky Arnold,
 Brian Ford, and
 Elliot V. Hersh
Figure 3.
Figure 3.

Analgesic Doses Taken During the First 72 Hours Postoperatively in Opioid-Using and Opioid-Naïve Patients.

Patients with chronic pain on opioid therapy used more analgesics (mean, SD) during the first 72 hours postoperatively vs opioid-naïve patients without chronic pain.

Subject Index, Volume 62
Article Category: Research Article
Volume/Issue: Volume 62: Issue 4
Online Publication Date: Dec 01, 2015
DOI: 10.2344/0003-3006-62.4.180
Page Range: 180 – 180

Flow dynamics, 125 Gelfoam, 22 General anesthesia, 20, 22, 31, 66, 122, 168 Hydroxyzine, 91 Hyperalgesia, 135 Hypercapnia, 51 Hypocapnia, 51 Inferior alveolar nerve block, 106, 135 Injection speed, 106 Intravenous deep sedation, 25 Intravenous fluids, 168 Irreversible pulpitis, 14, 135 Ketamine, 25 Laryngeal mask airway, 20 Lidocaine, 106 Local anesthesia, 106, 153 Main-stem intubation, 66 Management of pediatric cardiac arrhythmias

JDSA Abstracts
Article Category: Abstract
Volume/Issue: Volume 57: Issue 3
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.3.121
Page Range: 121 – 128

, consolidation, and storage of information, but not recognition or recall; b) The amnesic effect would not remain in a short-duration sedation by PPF, but can remain in a short duration sedation by DEX. Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University High Dose Remifentanil Administration during Orthognathic Surgery is Associated with Postoperative Hyperalgesia Hideharu Agata, JunkoYumura*, Manabu Miki and Toshiya Koitabashi 2010

JDSA Abstracts
Article Category: Abstract
Volume/Issue: Volume 58: Issue 1
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.1.43
Page Range: 43 – 51

The Effect of Sevoflurane or Propofol on the Postoperative Hyperalgesia Following High-dose Remifentanil Anesthesia 2010 ; 38 ( 2 ): 180 – 186 . Remifentanil, an ultra short-acting μ opioid receptor agonist may be associated with postoperative hyperalgesia. It has been reported that hyperalgesia can be prevented by either decreasing the remifentanil doses or by coadministration with N-methyl-D-aspartate (NMDA) receptor antagonists. Both sevoflurane and propofol have been known to antagonize the NMDA receptor. Thus, we

JDSA Journal Abstracts
Article Category: Abstract
Volume/Issue: Volume 53: Issue 3
Online Publication Date: Jan 01, 2006
DOI: 10.2344/0003-3006(2006)53[111:JJA]2.0.CO;2
Page Range: 111 – 113

. It has been reported that hyperalgesia is caused by central sensitization in the spinal dorsal horn neuron due to activation of nociceptive transmission of nitric oxide (NO). Recently, it has been suggested that propofol, the most frequently used intravenous anesthetic agent for induction and maintenance of general anesthesia and sedation, may influence the production of NO in the central nervous system and systemic circulation. We hypothesized that subhypnotic doses of propofol may modulate hyperalgesia by altering the spinal release of nitric oxide. Although