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Hydromorphone/morphine Hyperalgesia: case report A 29-year-old woman with sickle cell anaemia developed hyperalgesia while receiving morphine and hydromorphone [routes and durations of treatment to reaction onset not stated] for severe chronic pain. The woman had experienced severe chronic pain since her teenage years, treated with daily opioids. However, her quality of life had remained poor due to persistent severe pain and frequent hospitalisations. On presentation, her opioid therapy consisted of extended-release morphine 100mg twice daily, in addition to up to 40mg of hydromorphone daily for breakthrough pain. Over the following 6 months, she was hospitalised on six occasions and received aggressive treatment including patientcontrolled analgesia with hydromorphone. Her pain scores were persistently elevated, preventing her from sleeping. Severe opioid tolerance with refractory pain and opioidinduced hyperalgesia were considered. A ketamine infusion protocol, to be used with patientcontrolled analgesia with opioids, was initiated after the woman declined treatment with methadone. She was treated with ketamine on three consecutive hospital admissions. Her pain scores subsequently improved; she reported that ketamine "allowed her to sleep and improved her quality of life". Axelrod DJ, et al. Clinical vignette - Ketamine for severe sickle cell painful episodes in an opioid tolerant patient. American Journal of Hematology 86: 56, No. 10, Oct 2011. Available from: URL: http://dx.doi.org/10.1002/ajh.22152 803066630 [abstract] - USA

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Reactions 11 Feb 2012 No. 1388