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ANALGESIA

A Differential Diagnosis of Hyperalgesia, Toxicity, and Withdrawal from Intrathecal Morphine Infusion

Aneesh Singla, MD, MPH^*, Milan P. Stojanovic, MD^*, Lucy Chen, MD^*, and Jianren Mao, MD, PhD^*

From the *Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School; Department of Anesthesia and Critical Care, MGH Pain Center; and Department of Anesthesia and Critical Care, MGH Center for Translational Pain Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Aneesh Singla, MD, MPH, Department of Anesthesia and Critical Care, 35 Fay St., #E-504, Boston, MA 02118. Address e-mail to asingla{at}partners.org.

Abstract

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.