Oxycodone use can result in increased sensitisation to pain (hyperalgesia). Her oxycodone dosage was increased in response. The patient.
Healthcare professionals should be aware that the use of oxycodone can result in hyperalgesia.
Reports may be submitted via the Medsafe website ( /profs/adverse/reactions.asp ) or by reporting directly to CARM ( https://nzphvc.otago.ac.nz/carm/ ). Healthcare professionals are encouraged to report any adverse events to the Centre for Adverse Reactions Monitoring (CARM).
OIH is thought to result from neuroplastic changes in the central nervous system and peripheral nervous system leading to sensitisation of pro-nociceptive pathways 1.
The Centre for Adverse Reaction Monitoring (CARM) has received a report of a female patient who was receiving oxycodone for neuropathic pain (post juvenile idiopathic arthritis) reported a more intense pain that spread to involve her whole body. Her oxycodone dosage was increased in response. The patient was admitted to hospital where hyperalgesia was diagnosed. The patient was weaned off oxycodone and commenced on morphine. At the time of the report, the patient was improving.
Prescriber Update 36(3): 34 September 2015.
Opioid-induced hyperalgesia (OIH) is a state of nociceptive (nerve cell) sensitisation caused by exposure to opioids whereby the patient receiving opioids for the treatment of pain may become more sensitive to pain 1.
If OIH is suspected, opioid reduction, opioid rotation or the use of a non-opioid strategy for pain control should be considered 1–4.
Tolerance occurs when there is a progressive lack of response to a medicine resulting in increased dosage 2. However, they are distinct pharmacologic phenomena 1. Tolerance can be overcome by increasing the medicine dosage. In contrast, OIH cannot be overcome by increasing the dosage. It is important to note that OIH and analgesic tolerance can both result in a similar effect on opioid dose requirements 1.
Search: Data Sheets Consumer Medicine Information Product/Application Search Report a Problem.
Published: 2 September 2015.
OIH should be suspected if the opioid treatment effect wanes in the absence of disease progression, particularly if in association with unexplained pain or pain from ordinarily non-painful stimuli 1.
Medicines Adverse Reactions Committee CARM Ministry of Health New Zealand Formulary HQSC Medication Safety.
An oxycodone dose reduction or change in opioid may be required ” 3,4. “ Hyperalgesia that will not respond to a further dose increase of oxycodone may very rarely occur in particular at high doses. The New Zealand data sheets for oxycodone lists the frequency of hyperalgesia as not known and includes the following precaution.