Does Fentanyl Cause Hyperalgesia and Increase Post-ER Opioid Usage?

Written by Jonathan Brewer

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Patients treated with fentanyl during their emergency department (ED) stay for acute pain did not consume more opioids after ED discharge compared to those treated with other opioids during their ED stay.

Why does this matter?
Hyperalgesia (higher sensitivity to pain) has been associated with fentanyl usage and can theoretically contribute to increasing opioid usage. This paper assessed the relationship between acute pain management with fentanyl in the ED when compared to other opioids and if the quantity of opioids consumed two weeks after discharge was affected.

Treat the pain
Patients in this study were separated into two prospective cohorts that each suffered from an acute pain condition (defined as ≤ 2 weeks duration). Both were treated with an opioid in the ED and subsequently discharged home with an opioid prescription. Patients then completed a 14-day diary of pain medication usage. Afterward, the quantity of 5 mg morphine equivalent (MME) tablets consumed during that time was analyzed.

Within the 707 patients in this study, those treated with fentanyl in the ED (N = 91) consumed a median of 5.8 MME compared to 7.0 MME for those treated with other opioids (p=0.05). Using propensity score matching, results were almost identical (5.6 MME, fentanyl vs 7 MME, other opioid). When adjusted for confounding variables (type of painful condition and quantity of opioids prescribed at discharge), ED fentanyl treatment also showed a non-statistically significant association with decreased opioid consumption during the 14-day follow up (unstandardized regression coefficient = -2.4; 95%CI -5.3 to 0.4; p = 0.09).

This study was limited by having no randomization and no standardization of opioid quantity prescribed at ED discharge, leading to possible selection bias. However, this does not convince me that fentanyl leads to a post-ED discharge hyperalgesia, and I will continue to use fentanyl when indicated in the ED.

Source
Association between fentanyl treatment for acute pain in the emergency department and opioid use two weeks after discharge. Am J Emerg Med. 2022 Feb;52:137-142. doi: 10.1016/j.ajem.2021.11.041. Epub 2021 Dec 4.

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