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changes in the tibialis posterior tendon in individuals with TPT. J Orthop Sports Phys Ther 2021;51(5)253-260. Epub 28 Mar 2021. doi10.2519/jospt.2021.9707.Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate. To address a lack of perioperative awareness, we present an educational review of clinically relevant aspects of the disorder. Although the mechanisms of OIH are thought to primarily involve medullary descending pathways, it is likely multifactorial with several