Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study
Opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity associated with ongoing opioid use, may worsen the postoperative pain experience. This pilot study examined the effect of chronic opioid use on pain responses in patients undergoing a standardized dental surgery. Experimental and subjective pain responses were compared prior to and immediately following planned multiple tooth extractions between patients with chronic pain on opioid therapy (≥30 mg morphine equivalents/d) and opioid-naïve patients without chronic pain matched on sex, race, age, and degree of surgical trauma. Preoperatively, chronic opioid users rated experimental pain as more severe and appreciated less central modulation of that pain than did opioid-naïve participants. Postoperatively, chronic opioid-using patients rated their pain as more severe during the first 48 hours and used almost twice as many postoperative analgesic doses during the first 72 hours as the opioid-naïve controls. These data suggest that patients with chronic pain taking opioids approach surgical interventions with heightened pain sensitivity and have a more severe postoperative pain experience, providing evidence that their complaints of postoperative pain should be taken seriously and managed appropriately.Objective:
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(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.
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.
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.
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