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Hyperalgesia during opiate escalation in a patient with sickle cell anemia managed by de-escalation of opiates

Chinedu Ivonye, Susan Hanson, Abdurahman Emsalem, Emmanuel Onasile, Vishal Parekh, Christopher Phillips, Stephanie Garrett

Am J Case Rep 2009; 10:126-128

ID: 878182

Background: Traditionally, using opioid analgesics to treat of sickle cell pain, a decline in analgesic efficacy had been thought to result from development of pharmacological tolerance or worsening symptoms. Opioids intended to abolish pain can unexpectedly produce hyperalgesia, especially during rapid escalation of opioids. To avoid this adverse effect, practitioners should consider opioid switching or down escalation.
Case Report: The authors present a case report of a sickle cell patient with a crisis in which overlap switching of morphine to methadone was effective in treatment of hyperalgesia as a consequence of rapid opioid escalation. Interestingly there was clinical and symptomatic improvement when the initial opioid was switched to a low dose of a different opioid resulting in the resolution of the hyperalgesia.
Conclusions: Hyperalgesia in opioid escalation has been reported in the medical literature in cancer patients and in children with sickle cell pain crises. However the occurrence of hyperalgesia associated with opioid escalation in adults with sickle cell pain has not been suffi ciently documented in the literature. Physicians should be aware of this possible consequence of opiate therapy and how to treat it.

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