Combination Therapy with Pregabalin and Morphine Relieves Dinutuximab-Induced Pain in a 3-Year-Old Girl: A Case Report.

Abstract

Introduction: Opioids are commonly initiated prior to dinutuximab (DIN)-an anti-disialoganglioside 2 antibody used in the treatment of neuroblastoma-and continued for approximately 2 hours after administration to manage DIN-associated pain. However, pain control remains insufficient with standard opioid treatment.

Methods: We treated a 3-year-old girl with high-risk neuroblastoma who received DIN after tandem transplantation. During the first treatment cycle, despite scheduled morphine therapy, she developed abdominal pain rated as 5 on the Faces Pain Scale (FPS; range 0-5, where 0 indicates no pain and 5 indicates the worst pain), indicating the need for higher doses, prolonged infusion, and additional bolus analgesia. The dosing period and DIN dosage in the second cycle were similar to those in the first cycle. To improve pain control during the second cycle, pregabalin was initiated at a dose of approximately 1 mg/kg/day 3 days prior to DIN administration.

Results: This approach significantly reduced abdominal pain, with the maximum FPS score decreasing to 2.

Conclusion: This case highlights that adding pregabalin to standard opioid therapy can contribute to improved management of DIN-induced pain.