Hydromorphone-induced hyperalgesia in a patient with metastatic pancreatic cancer

AbstractOn the basis of the case report of a 13-year-old boy with metastatic pancreatic cancer undergoing palliative treatment, the phenomena of tolerance and opioid-induced hyperalgesia are demonstrated. Both can make efficient pain control much more difficult. Chronic use of opioids, especially in high doses, can trigger pronociceptive processes such as activation of the N-methyldiaspartate (NMDA) receptor, the increase of spinal dynorphin concentration with release of stimulating neurotransmitters, and/or the activation of descending nerve-excitation paths. As far as is known today, the only one of these processes that can be attenuated by ketamine is sensitisation of the NMDA receptor. Alternatively, regionally used methods of analgesia can be employed.