skip to main content

Opioid-induced hyperalgesia — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardPain MedicineOpioid-induced hyperalgesiaFRCA Final

A 52-year-old man on long-term high-dose oxycodone for chronic pancreatitis reports worsening diffuse abdominal pain despite escalating doses. He is drowsy, constipated and says pain improves briefly after dose increases then returns more widely. What is the most likely cause of the complication?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Opioid-induced hyperalgesia with opioid toxicity

Widespread worsening pain with escalating opioid requirement and toxicity features suggests opioid-induced hyperalgesia. Acute pathology must be considered, but the pattern of diffuse pain amplification after repeated dose escalation is typical. Further opioid escalation may worsen both pain sensitivity and adverse effects. Management requires specialist review, opioid rationalisation, non-opioid strategies and psychological support.

Reference: Faculty of Pain Medicine opioids aware guidance; NICE chronic pain guidance NG193