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Related Experiment Videos

Morphine hyperalgesia: a case report.

George R Wilson1, Gary M Reisfield

  • 1Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville, Florida, USA.

The American Journal of Hospice & Palliative Care
|December 3, 2003
PubMed
Summary
This summary is machine-generated.

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Opioid-induced hyperalgesia can occur with high-dose opioid therapy for intractable pain. Reducing the intrathecal morphine dose rapidly resolved this condition, making the patient pain-free.

Area of Science:

  • Oncology
  • Pain Management
  • Pharmacology

Background:

  • Metastatic testicular cancer often presents with intractable pain.
  • Managing refractory cancer pain frequently requires high doses of opioids and adjuvant analgesics.

Observation:

  • A patient with metastatic testicular cancer developed opioid-induced hyperalgesia despite escalating doses of oral, intravenous, and intrathecal (IT) opioids.
  • This uncommon phenomenon was characterized by worsening pain despite increased opioid administration.

Findings:

  • Opioid-induced hyperalgesia was identified as the cause of intractable pain.
  • A significant reduction (100-fold) in intrathecal morphine dosage led to rapid resolution of hyperalgesia.
  • The patient achieved pain freedom after opioid adjustment and remained so until death.

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Implications:

  • Recognizing opioid-induced hyperalgesia is crucial when high-dose opioid therapy, particularly neuraxial, fails to control pain.
  • Appropriate opioid dose adjustment, including reduction, is key to managing this treatable side effect.
  • This case highlights the importance of considering paradoxical opioid effects in complex pain management scenarios.