Case of the Month #28: Opioid-induced hyperalgesia by Dr Nofil Mulla

Published: 30/05/2023

Future developments

Future research into quantitative sensory testing methods coupled with a consensus definition of OIH could improve screening and prevention. Because the current guidelines for opioid tapering are in the absence of large-scale randomised trials, more research on this topic is needed.  There are many promising new avenues for additional therapies in the treatment of OIH. The efficacy of dextromethorphan (an NMDA receptor antagonist), Duloxetine, cyclooxygenase-2 inhibitors, Melatonin, Dexmedetomidine and Clonidine are promising non-opioid drugs that could ameliorate OIH but require further investigation. Successful prospective randomised trials of non-opioid and biased opioid targets would herald the promise of eliminating OIH and even reversing the opioid epidemic.