PMID- 35435616
OWN - NLM
STAT- MEDLINE
DCOM- 20220609
LR  - 20220913
IS  - 1534-6277 (Electronic)
IS  - 1534-6277 (Linking)
VI  - 23
IP  - 7
DP  - 2022 Jul
TI  - Complex Persistent Opioid Dependence-an Opioid-induced Chronic Pain Syndrome.
PG  - 921-935
LID - 10.1007/s11864-022-00985-x [doi]
AB  - Long-term opioid therapy (LTOT) for chronic cancer and non-cancer pain is 
      commonly ineffective in providing its stated goal of improving function through 
      good control of pain. Opioid tapering (slow dose reduction and/or 
      discontinuation), the logical solution, also appears to be ineffective among many 
      patients on LTOT as it often leads to even worse pain control and function, 
      leaving the patients and providers managing LTOT in a clinical conundrum with 
      little treatment choices. Complex persistent opioid dependence (CPOD) was 
      recently offered as a heuristic to explain this clinical conundrum exemplified by 
      the ineffectiveness of both LTOT and opioid tapering. This manuscript provides a 
      detailed description of the neurobehavioral underpinnings of CPOD, explaining how 
      long-term opioid use can lead to more pain even while experiencing relief with 
      each opioid dose. CPOD is characterized by the allostatic opponent mechanisms of 
      neuroadaptations related to the progression of opioid dependence and tolerance 
      involving nociceptive/anti-nociceptive brain systems causing opioid-induced 
      hyperalgesia and reward/anti-reward systems causing hyperkatefia or suffering 
      that induces pain experience through the cognitive/emotional component of pain 
      mechanisms. "Opioid Induced Chronic Pain syndrome" (OICP) is offered as an 
      alternate clinical diagnostic term instead of CPOD that has several limitations 
      as a diagnosis term including poor patient acceptance due to stigma towards 
      addiction and clinical confounding with opioid use disorder, a related but 
      separate clinical entity. OICP with LTOT is conceptualized as a recoverable 
      iatrogenic problem that can be managed by pain providers. Broad guidance on 
      management of OICP is also provided.
CI  - (c) 2022. This is a U.S. government work and not under copyright protection in the 
      U.S.; foreign copyright protection may apply.
FAU - Manhapra, Ajay
AU  - Manhapra A
AUID- ORCID: 0000-0001-9208-1490
AD  - Pain Medicine, Hampton VA Medical Center, 100 Emancipation Drive, Hampton, VA, 
      23667, USA. ajay.manhapra@yale.edu.
AD  - New England Mental Illness Research Education and Clinical Center (MIRECC), West 
      Haven, CT, USA. ajay.manhapra@yale.edu.
AD  - Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. 
      ajay.manhapra@yale.edu.
AD  - Departments of Physical Medicine and Rehabilitation and Psychiatry, Eastern 
      Virginia Medical School, Norfolk, VA, USA. ajay.manhapra@yale.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220418
PL  - United States
TA  - Curr Treat Options Oncol
JT  - Current treatment options in oncology
JID - 100900946
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Analgesics, Opioid/adverse effects
MH  - *Chronic Pain/diagnosis/drug therapy/etiology
MH  - Humans
MH  - *Neoplasms/drug therapy
MH  - *Opioid-Related Disorders/diagnosis/drug therapy/etiology
MH  - Pain Management
OTO - NOTNLM
OT  - Allostatic opponent effect
OT  - Analgesia
OT  - Hyperkatefia
OT  - Long-term opioid therapy
OT  - Opioid taper
OT  - Opioid-induced hyperalgesia
OT  - Opioids
OT  - Pain
OT  - Protracted withdrawal syndrome
OT  - Relief
EDAT- 2022/04/19 06:00
MHDA- 2022/06/10 06:00
CRDT- 2022/04/18 12:08
PHST- 2022/03/31 00:00 [accepted]
PHST- 2022/04/19 06:00 [pubmed]
PHST- 2022/06/10 06:00 [medline]
PHST- 2022/04/18 12:08 [entrez]
AID - 10.1007/s11864-022-00985-x [pii]
AID - 10.1007/s11864-022-00985-x [doi]
PST - ppublish
SO  - Curr Treat Options Oncol. 2022 Jul;23(7):921-935. doi: 
      10.1007/s11864-022-00985-x. Epub 2022 Apr 18.