Pain: opioid-induced hyperalgesia: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Pain: opioid-induced hyperalgesia

Sample item

A patient on escalating opioid doses for cancer pain develops more widespread pain with allodynia, despite increasing doses. What is the best next step?

AReduce or rotate the opioid and add an adjuvant such as ketamineBAdd a benzodiazepine for painCDouble the opioid dose againDStop all analgesics abruptly

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Reduce or rotate the opioid and add an adjuvant such as ketamine

Opioid-induced hyperalgesia is a paradoxical increase in pain sensitivity with escalating opioid doses, thought to involve NMDA receptor activation. Management is dose reduction or opioid rotation, with NMDA antagonists such as ketamine and non-opioid adjuvants. Distinguishing it from tolerance or disease progression is important, because increasing the dose worsens it.

Option by option

A. Reduce or rotate the opioid and add an adjuvant such as ketamine (correct)
Correct. Reducing or rotating the opioid, with an NMDA antagonist, is the recommended approach.
B. Add a benzodiazepine for pain
Benzodiazepines are not analgesics and add respiratory risk.
C. Double the opioid dose again
Increasing the dose can worsen hyperalgesia.
D. Stop all analgesics abruptly
Abrupt cessation would cause withdrawal and uncontrolled pain.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Reduce or rotate the opioid and add an adjuvant such as ketamine. Opioid-induced hyperalgesia is a paradoxical increase in pain sensitivity with escalating opioid doses, thought to involve NMDA receptor activation.

Why is "Add a benzodiazepine for pain" not the answer?

Benzodiazepines are not analgesics and add respiratory risk.

Why is "Double the opioid dose again" not the answer?

Increasing the dose can worsen hyperalgesia.

Why is "Stop all analgesics abruptly" not the answer?

Abrupt cessation would cause withdrawal and uncontrolled pain.

What concept does this question test?

It tests Pain: opioid-induced hyperalgesia in Anaesthesia. Management is dose reduction or opioid rotation, with NMDA antagonists such as ketamine and non-opioid adjuvants. Distinguishing it from tolerance or disease progression is important, because increasing the dose worsens it.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pain: opioid-induced hyperalgesia?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.