A differential diagnosis of hyperalgesia, toxicity, and withdrawal from intrathecal morphine infusion.
Opioid-induced hyperalgesia, toxicity, and withdrawal are phenomena that may occur with intrathecal opioid infusion. We present a case in which a patient received intrathecal morphine infusion, and then experienced a clinical course that may have involved hyperalgesia, toxicity, and/or withdrawal. The possible differential diagnosis of opioid-induced hyperalgesia, toxicity, and withdrawal, and its implications in clinical pain management, are discussed. This report demonstrates the complexity of treating patients with long-term continuous intrathecal opioids when modest adjustment of the intrathecal cocktail results in a paradoxical clinical course.
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. asingla@partners.org
Aneesh
A
Singla
Milan P
MP
Stojanovic
Lucy
L
Chen
Jianren
J
Mao
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D007278:Injections, Spinal; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000175:diagnosis*
D009020:Morphine