50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Epidural Analgesia Affords Relief of Acute on Chronic Prostate Cancer Pain with Associated Opioid Induced Hyperalgesia

Aaron Hawke, DO. Brian Sites, MD.

Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH

Introduction

•Opioid induced hyperalgesia (OIH) describes a heightened pain state arising from exposure to opioids and is thought to result from neuroplastic changes in the peripheral and central nervous systems leading to sensitization1.

•In OIH, the therapeutic response to opioid therapy wanes and pain intensifies with escalation of opioid therapy despite lack of underlying disease progression. This is often accompanied by widespread allodynia unrelated to the initial pain generator1.

•Patients receiving higher doses of opioids are often more sensitive to pain, and individuals receiving >100 morphine milligram equivalents (MME) daily tend to display a lower pain tolerance1,2.

•Treatment of OIH includes opioid dose reduction, opioid rotation, tapering, and the introduction of NMDA receptor modulators1.

•This case demonstrates the use of epidural analgesia in managing a pain crisis in a patient with acute on chronic cancer pain and OIH.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

EPIDURAL ANALGESIA AFFORDS RELIEF OF ACUTE ON CHRONIC PROSTATE CANCER PAIN WITH ASSOCIATED OPIOID INDUCED HYPERALGESIA

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