Pain managements in pancreatic cancer patient with opioid-induced hyperalgesia: A case report

Park, Jung Hyun; Lim, Dae Hwan; Kim, Young Hoon; Ryu, Keon Hee; Moon, Dong Eon

Case Report

Spinal Pain

Anesthesia and Pain Medicine 2012;7(2):110-113.
Published online May 1, 2012.

Pain managements in pancreatic cancer patient with opioid-induced hyperalgesia: A case report

Jung Hyun Park, Dae Hwan Lim, Young Hoon Kim, Keon Hee Ryu, Dong Eon Moon

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. demoon@catholic.ac.kr

Abstract

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.

Key Words: Cancer pain, Opioid, Opioid-induced hyperalgesia