Melanie Cutbirth1
1) United States
Treatment Approaches: Pharmacological, interventional treatment
Melanie Cutbirth, MS, RN, CPNP, Department of Anesthesiology and Pain Medicine, Pain Management Nurse Practitioner, Seattle Children’s Hospital, Seattle, WA, USA, melanie.cutbirth@seattlechildrens.org, MB-11-533 4800 Sandpoint Way NE, Seattle, WA 98105, 206-987-1572, 206-987-3935
Opioid-induced hyperalgesia (OIH) is most broadly defined as a state of nociceptive sensitization caused by exposure to opioids at varying doses and lengths of use, resulting in multiple manifestations. The prevalence of OIH has not been reported, but there are some anecdotal observations that suggest that OIH is not as rare of a side effect as previously thought. Unfortunately, many times, this diagnosis may go unrecognized. There have been increasing amounts of research on OIH, but the data available within pediatrics is scarce. One extreme case of OIH in the pediatric setting was in an international 15 year old male with a history of refractory acute lymphoblastic leukemia (ALL) who was placed on Hospice in his home country. He traveled to the United States (US) for investigational CAR T-Cell immunotherapy in an attempt to cure his disease. While on hospice his opioid use increased rapidly and over time he developed OIH. Once he reached the US, the inpatient pain consultation service implemented multiple interventions to help eventually alleviate his OIH. There were many cultural, ethical, and medical hurdles to overcome to provide the best possible care for this patient. We review the mechanism of OIH, the diagnosis and treatment in this patient, and the multidisciplinary approach to treating his pain syndrome.
