title: High-dose daily opioid administration and poor functional status intensify local anesthetic injection pain in cancer patients.
abstract: BACKGROUND
  Evidence for opioid-induced hyperalgesia (OIH) has been shown in animal and human studies, but the clinical implications of this phenomenon remain unclear.
  
  
  OBJECTIVE
  We examined whether cancer patients taking opioids differ in their sensitivity to a clinical pain stimulus using a local anesthetic injection compared to those not taking opioids. We also evaluated the effect of the opioid dose, duration of opioid therapy, and patients' pain severity and functional status on this clinical pain stimulus.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University outpatient department for interventional pain management, Republic of Korea.
  
  
  METHODS
  Eighty-two cancer patients including 20 patients not taking opioids (non-opioid group) and 62 taking opioids (opioid group) who were scheduled for an interventional procedure were enrolled in this study. Patients received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic (LA). Before the injection, patients completed the Brief Pain Inventory (BPI) questionnaire and were asked to rate their current pain using numeric rating scales. Immediately following the injection, LA injection-specific pain was evaluated using pain intensity, unpleasantness, and behavior pain scores.
  
  
  RESULTS
  LA injection-specific pain intensity, unpleasantness, and behavior pain score were significantly higher in the opioid group compared with the non-opioid group (P < 0.001). In the opioid group, these post-injection pain scores were higher in patients taking high-dose opioids than those taking low doses (P < 0.05). In addition, we observed a strong correlation between the baseline BPI pain interference score and the LA injection-specific pain score (r = 0.695, P < 0.001).
  
  
  CONCLUSIONS
  This study is limited by its sample size and observational design. Various opioid medications, which were not standardized, may have inadvertently biased our results. Finally, the pain assessed by a brief stimulus does not fully reflect disturbances in endogenous pain inhibitory processes.
  
  
  CONCLUSIONS
  The results of this study suggest that opioid medication is an important contributing factor to pain perception accompanying LA injection, and cancer patients using high-dose opioids may be highly susceptible to hyperalgesic responses to this clinical stimulus. We also suggest that the possible presence of OIH may be intensified among cancer patients with poor physical and psychosocial functional status.
authors.affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Shin Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Duck Mi
authors.initials: DM
authors.lastname: Yoon
authors.forename: Kwan Woong
authors.initials: KW
authors.lastname: Choi
authors.forename: Kyung Bong
authors.initials: KB
authors.lastname: Yoon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D019370:Observation; D010045:Outpatients; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local