[INTENSIVE PALLIATIVE CARE FOR INTRACTABLE PAIN]

Opioid drugs are the most powerful painkillers known. Thus, they are the pivotal treatment for the severe pain often associated with oncological disease. Most of their side effects are known and common. Opioid-induced hyperalgesia (OIH) is one of their unknown and uncommon side effects. This phenomenon is characterized by a paradoxical reaction to opioid administration. In this condition, an increase in the dose and frequency of opioid administration aggravates the pain instead of reducing it. Misdiagnosis of this phenomenon can result in excessive opioids usage which does not relieve the pain, and opioid dependency effect. Presented below is a case report of a young man suffering from Ewing's sarcoma who was referred to the Emergency Department due to a pain crisis. During the last year, he was treated with accelerated doses of many opioids, up to ten times the maximal accepted dose of methadone. To alleviate his severe and intractable pain he was admitted to the Intensive Care Unit where he was sedated and ventilated. During his hospitalization he was diagnosed with OIH and underwent an opioid withdrawal procedure called ultra rapid opioid detoxification (UROD). After five days of hospitalization, he was discharged and sent home opioid-free. This paper will discuss therapeutic dilemmas that arise when dealing with pain balance in the unique and challenging circumstances described.