Pain Management of Complicated Opioid-Induced Hyperalgesia in Setting of Sickle Cell Disease: A Case Report

30% to 40% of adolescents and adults living with sickle cell disease (SCD) suffer from chronic pain (1). Creating individualized pain management plans in patients with SCD can be a challenge. Many patients with SCD are on chronic opioid therapy (COT), which can increase risk of opioid-induced hyperalgesia. Terms such as dependence and tolerance are often incorrectly used interchangeably for patients with opioid-induced hyperalgesia. Although the mechanism of opioid-induced hyperalgesia is not completely understood, it has been proposed that NMDA receptor activation increases excitability of neurons, and thus painful stimuli through the influx of calcium ions when given opioids extensively (2). Here we introduce the challenging case of a patient with opioid-induced hyperalgesia in the setting of COT. Our multi-disciplinary, individualized approach involving hematology, pain management, ICU, and neurology proved valuable. Shared decision making in pain management between physicians and the patient allowed for eventual safe and stable discharge.