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[INTENSIVE PALLIATIVE CARE FOR INTRACTABLE PAIN].

Ehud Paz^1,2, Oded Vofsi^3,4, Kzia Cohen¹

¹Intensive Care Unit, Emek Medical Center.

|May 24, 2022

Summary

Opioid-induced hyperalgesia (OIH) is a rare side effect where more opioids worsen pain. This case report details managing OIH in an advanced cancer patient through ultra-rapid opioid detoxification.

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Area of Science:

Oncology
Pain Management
Pharmacology

Background:

Opioids are crucial for severe cancer pain, but uncommon side effects like opioid-induced hyperalgesia (OIH) can occur.
OIH is a paradoxical reaction where increased opioid dosage intensifies pain, potentially leading to misdiagnosis and dependency.
Effective pain management in oncology requires recognizing and addressing OIH.

Observation:

A young patient with Ewing's sarcoma experienced a severe pain crisis despite escalating opioid doses, including methadone up to ten times the maximum.
The patient required intensive care, sedation, and ventilation due to intractable pain.
Diagnosis of OIH was established during hospitalization.

Findings:

The patient underwent ultra-rapid opioid detoxification (UROD) to manage OIH.
Following UROD, the patient was successfully discharged opioid-free within five days.
This case highlights the successful management of OIH in a complex oncological pain scenario.

Implications:

Accurate diagnosis of OIH is critical to avoid escalating opioid use and dependency.
UROD presents a viable treatment option for managing OIH in patients with severe pain.
This case underscores the importance of considering OIH in refractory cancer pain and exploring alternative detoxification strategies.