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Opioid Hypermetabolism in a Multiextremity Spine Trauma Patient: A Case Report
Stephen Fanous1,2, Zach Denton2, Nicolette Saddler1
1Department of Orthopedic Surgery, Children's Mercy Hospital, Kansas City, Missouri.
Case:
A 17-year-old man presented with an unstable C5 flexion-compression injury and bilateral comminuted distal radius fractures after a motorcycle collision. Despite standard opioid therapy, he experienced difficulty with pain control during and after treatment. Genetic testing revealed a polymorphism in the cytochrome P450 2D6 (CYP2D6) gene, resulting in ultrarapid metabolism.
Conclusion:
Genetic mutations in CYP2D6 can result in impaired opioid metabolism and impaired pain control. Impaired pain control in musculoskeletal trauma patients should raise concern for a potential CYP2D6 mutation. A proper understanding of this condition and adjustments in pain management can guide optimal care for these patients.
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