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Mechanisms, Diagnosis, and Medical Management of Hyperalgesia: an Educational Review

  • Pain Medicine (GJ Meredith, Section Editor)
  • Published:
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Abstract

Purpose of the Review

Hyperalgesia may be an iatrogenic consequence of surgery or pain management. Thus, it is essential for anesthesiologists, pain management specialists, surgeons, and primary care physicians to regularly update their awareness and strategies for addressing this problem. This educational review of hyperalgesia provides up-to-date knowledge of the contributing mechanisms, differential diagnoses, and medical therapy. A particular focus is placed on common types of postoperative hyperalgesia and recent evidence that anesthesiologists and surgeons should be aware of.

Recent Findings

Hyperalgesia may acutely manifest due to tissue injury and peripheral sensitization; it can progress to a chronic condition developing from central nervous system sensitization. While clinical evaluation begins with a detailed history, physical examination, and sensory testing, an improved understanding of the clinical and cellular mechanisms involved in hyperalgesia pathology continues to drive future research and advance our understanding of this complex presentation.

Summary

Opioid-induced hyperalgesia may be confused with opioid tolerance and withdrawal and must also be differentiated from other diagnoses to optimize patient management and promote disease regression. Hyperalgesia is a common clinical condition with evolving guidelines for testing and treatment. Opioid-induced hyperalgesia is a potential cause of hyperalgesia and must be differentiated to optimize therapeutic decision-making.

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Fig. 1

reproduced with permission from Roekel, Neuroscience, 2016;338:160–82 [26])

Fig. 2

reproduced with permission from Cook, Trend Immunol 2018;39:240–55 [40])

Fig. 3

reproduced with permission from Dureja, J Pain Res 2017;10:709–36 [43]

Fig. 4

reproduced with permission from Viana, Handb Clin Neurol 2018:156:103–19 [77])

Fig. 5

reproduced with permission from Gilron, Lancet Neurol 2013;12:1084–95 [7])

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Acknowledgements

KMH acknowledges support from National Institute of Child and Human Development (HD098193).

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC, USA

    Sylvia H. Wilson

  2. Department of Obstetrics & Gynecology, NorthShore University HealthSystem & Pritzker School of Medicine, University of Chicago, Evanston, IL, USA

    Kevin M. Hellman

  3. Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA

    Dominika James

  4. Department of Anesthesiology & Pediatrics, Texas Children’s Hospital, Houston, TX, USA

    Adam C. Adler & Arvind Chandrakantan

  5. Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA

    Adam C. Adler & Arvind Chandrakantan

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Wilson, S.H., Hellman, K.M., James, D. et al. Mechanisms, Diagnosis, and Medical Management of Hyperalgesia: an Educational Review. Curr Anesthesiol Rep 11, 524–540 (2021). https://doi.org/10.1007/s40140-021-00485-y

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