Do you think that opioid-induced narcotic hyperalgesia is real? I believe it has happened to some patients, but have seen it very infrequently in the past decade, and the literature does not support this as a significant clinical problem at this point. However, the current data may support opioid-induced hyperalgesia, post-surgery, in patients who have received certain kinds of fentanyl products. The main thing is to talk to the patient and always determine whether the medicine is doing more "for the patient" or "to the patient," and adjust the therapy appropriately. -- Response provided by John F. Peppin, DO, FACP
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