• Nabil Hina, Dominique Fletcher, Frédérique Poindessous-Jazat, and Valéria Martinez.
• From the Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches (NH, DF,VM), INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Boulogne Billancourt (DF,FP-J,VM), and Université Versailles Saint-Quentin, Versailles, France (DF).
• Eur J Anaesthesiol. 2015 Apr 1; 32 (4): 255-61.

BackgroundChronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear.ObjectivesTo assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery.DesignA prospective observational study.SettingsRaymond Poincare teaching hospital.PatientsAdults with or without long-term opioid treatment, scheduled for orthopaedic surgery.Primary Outcome MeasurePreoperative hyperalgesia was assessed with eight quantitative sensory tests, in a pain-free zone.Secondary Outcome MeasuresPostoperative morphine consumption and pain intensity were evaluated using a numerical rating scale (NRS) in the recovery room and during the first 72 h.ResultsWe analysed results from 68 patients (28 opioid-treated patients and 40 controls). Mean daily opioid consumption was 42 ± 25 mg of morphine equivalent. The opioid-treated group displayed significantly higher levels of preoperative hyperalgesia in three tests: heat tolerance threshold (47.1°C vs. 48.4°C; P = 0.045), duration of tolerance to a 47°C stimulus (40.2 vs. 51.1 s; P = 0.03) and mechanical temporal summation [1.79 vs. 1.02 (ΔNRS10-1); P = 0.036]. Patients in the opioid-treated group consumed more morphine (19.1 vs. 9.38 mg; P = 0.001), had a higher pain intensity (7.6 vs. 5.5; P = 0.001) in the recovery room and a higher cumulative morphine dose at 72 h (39.8 vs. 25.6 mg; P = 0.02).ConclusionChronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery.Trial RegistrationID-RCB 2011-A00304-37.

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