title: Acute-onset opioid-induced hyperalgesia in a child with juvenile idiopathic arthritis.
abstract: We describe a child with polyarticular juvenile idiopathic arthritis (JIA) presenting with severe diffuse pain refractory to nonsteroidal anti-inflammatory agents and high-dose opioids. Her JIA involved her knees and ankles and was mildly active on etanercept and nonsteroidal anti-inflammatory agents. At presentation, she complained of hip pain progressing to severe diffuse pain and allodynia involving her extremities. No abnormalities were seen in her laboratory parameters and imaging of her lower extremities. After appreciating no substantial benefit by increasing her opioids, her opioids were tapered and discontinued, and this was followed by significant alleviation in her pain, and a diagnosis of opioid-induced hyperalgesia (OIH) was made. Despite reports in adults, the phenomenon of OIH has been reported infrequently in children. To our knowledge, OIH has not been described in children with rheumatologic conditions. We recommend investigating the possibility of OIH when treating a child with JIA and severe refractory pain.
authors.affiliation: Department of Pediatrics, University of Florida, 1600 SWArcher Rd, Box 100296, Gainesville, FL 32610, USA. vvijayan@ufl.edu
authors.forename: Vini
authors.initials: V
authors.lastname: Vijayan
authors.forename: Ryan
authors.initials: R
authors.lastname: Moran
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Elder
authors.forename: Sukesh
authors.initials: S
authors.lastname: Sukumaran
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced* / Q000175:diagnosis*; D010148:Intractable Pain; D017211:Treatment Failure; D028761:Withholding Treatment
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal