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Induzieren Opioide Hyperalgesie?

Do opioids induce hyperalgesia?

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Zusammenfassung

Opioide stellen bis heute die potentesten Medikamente zur Therapie akuter und chronischer Schmerzen dar. Die paradoxe Beobachtung einer Hyperalgesie unter Opioidtherapie wurde in den zurückliegenden Jahren intensiv diskutiert. Diese sog. opioidinduzierte Hyperalgesie (OIH) ist als eine Sensitivierung nozizeptiver Signaltransduktionswege durch Opioide definiert. Sie resultiert in einer Abnahme der Schmerzschwelle für schmerzhafte Stimuli und zeigt sich klinisch durch einen gesteigerten Schmerzmittelbedarf oder eine gesteigerte Schmerzempfindlichkeit des Patienten. Über die genauen molekularen Mechanismen gibt es eine Vielzahl unterschiedlicher Hypothesen. Auch die klinische Relevanz der OIH wird unterschiedlich bewertet. Einzelne Berichte deuten bereits nach akuter, einmaliger intraoperativer Gabe eines Opioids auf einen vermehrten postoperativen Verbrauch von Schmerzmitteln hin. Auch bei chronischen Erkrankungen und Opioiddauertherapie wird in Einzelfällen über eine paradoxe Zunahme von Schmerzen berichtet, die nicht auf eine Progression der Grundkrankheit zurückzuführen ist. Im vorliegenden Beitrag werden die molekularen Mechanismen der Opioidtoleranz, des Opioidentzugs und andere Applikationsformen von Opioiden, die zur Hyperalgesie beim Patienten führen können, vorgestellt. Diese Arbeit soll einen Überblick geben, unter welchen Bedingungen die Applikation von Opioiden zu einer Hyperalgesie beim Patienten führen kann und welche klinische Bedeutung diese Hyperalgesie für die klinische Praxis hat.

Abstract

Opioids are the most potent drugs for treatment of acute and chronic pain. However, accumulating evidence suggests that opioids may paradoxically also enhance pain, often referred to as opioid-induced hyperalgesia. Opioid-induced hyperalgesia is defined as an increased sensitivity to pain or a decreased pain threshold in response to opioid therapy. Several mechanisms have been proposed to support opioid-induced hyperalgesia. However, it remains unclear whether opioid-induced hyperalgesia develops during continuous chronic application of opioids or on their withdrawal. This review provides a comprehensive summary of clinical research concerning opioid-induced hyperalgesia and the molecular mechanisms of opioid withdrawal and opioid tolerance and other potential mechanisms which might induce hyperalgesia during opioid therapy will be discussed. The status quo of our knowledge will be summarized and the clinical relevance of opioid-induced hyperalgesia will be discussed.

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  1. Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    C. Zöllner

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Zöllner, C. Induzieren Opioide Hyperalgesie?. Anaesthesist 59, 983–993 (2010). https://doi.org/10.1007/s00101-010-1803-x

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