allodynia, hyperalgesia, myoclonus, opioid-induced neurotoxicity



  1. Kozlov, Mary BS, RN
  2. Anderson, Mary Ann PhD, RN
  3. Sparbel, Kathleen J. H. PhD, APN, CNP, FNP-BC


A potential adverse effect of opioids in the hospice patient is a condition called opioid-induced neurotoxicity. It is a syndrome characterized by symptoms such as severe pain, tremors, seizures, confusion, and hallucinations and is easily missed by unaware clinicians. Hospice patients are particularly at risk because of high doses of opioids and some degree of renal failure. Retained opioid metabolites may cause neuroexcitatory and antianalgesic adverse effects. In this instance, the opioids can be a cause of patient suffering. As pain levels increase, the instinct of the provider is to increase the dose of the opioid. Unfortunately, this augments the pool of metabolites and further amplifies the symptoms. This in turn may lend to cyclical increases in opioid doses by well-meaning healthcare professionals. This article examines recent evidence-based literature regarding opioid-induced neurotoxicity and discusses clinical implications for nurses who care for the terminally ill. Key points of assessment and a framework of management strategies are provided to aid in effective symptom management.