What is the recommended approach for managing pain in a patient experiencing hyperalgesia who has been receiving fentanyl?

The recommended approach of switching fentanyl to ketamine is based on the understanding of hyperalgesia, which is a heightened sensitivity to pain that can occur with the prolonged use of certain opioid medications, such as fentanyl. When patients experience hyperalgesia, simply increasing the opioid dose may exacerbate the problem rather than alleviate pain.

Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, plays a unique role in pain management and is known for its potential benefit in conditions associated with opioid-induced hyperalgesia. By switching to ketamine, it may help to reset the pain pathways by interrupting the central sensitization that accompanies hyperalgesia. This approach is particularly advantageous as ketamine can provide analgesia without the risk of further opioid-related side effects, thus offering a more effective pain management strategy in this context.

The other options focus on modifying opioid therapy without addressing the underlying issue of hyperalgesia directly. While switching to an alternative opioid can provide analgesia, it does not necessarily resolve the heightened pain sensitivity resulting from prior fentanyl use. Therefore, transitioning to a non-opioid option like ketamine targets the root cause more effectively.