EpistemisHyperalgesia
Specialty: Neurology.
Why it occurs
- Painful peripheral neuropathy (diabetic, uremic, alcoholic)
- Trigeminal neuralgia or other cranial neuralgia
- Complex regional pain syndrome
- Fibromyalgia and states of generalized central sensitization
- Opioid-induced hyperalgesia (paradox due to prolonged use of high doses of morphine, fentanyl or oxycodone)
- Persistent compressive radiculopathy
Initial workup
Quantification of the pain threshold through stimulation with calibrated needles (monofilaments) or quantitative thermal stimulation; general analysis (glycemia, glycosylated hemoglobin, vitamin B12, kidney and thyroid function); electromyogram to study thick myelinated fibers.
red flags
Rapidly progressive hyperalgesia in a lower extremity accompanied by paleness, coldness, absence of peripheral pulses and severe swelling, which points to an ischemic vascular complication or compartment syndrome, rather than to a purely isolated peripheral neurological cause.
Standard management
- Duloxetine — 30-90 mg/day, selective serotonin and norepinephrine reuptake inhibitor
- Pregabalin — 150-450 mg/day
- Rotation of opioids or gradual reduction of opioids if opioid-induced hyperalgesia is suspected
- Ketamine in slow intravenous infusion (in hospital settings for the management of severe refractory hyperalgesia due to sensitization of NMDA receptors).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 6
- Treatment options
- 4