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Contributor: Donald Stader, MD Educational Pearls: Opioids target kappa and NMDA receptors that can lead to central nervous system sensitization and therefore increased pain For patients with opioid-induced hyperalgesia (OIH), oral ketamine (25-50 mg) can be used to treat their pain as it targets the NMDA receptor Other treatments is IV magnesium, NSAIDs, tylenol, and clonidine Buprenorphine and methadone are options for chronic pain management in the setting of OIH References Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145-161. Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. Donate to EMM today!