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PAIN MEDICINE

Opioid-Induced Hyperalgesia and Rapid Opioid Detoxification After Tacrolimus Administration

Antonio Siniscalchi, MD, Emanuele Piraccini, MD^*, Zuzana Miklosova, MD^*, Stefania Taddei, MD, Stefano Faenza, MD, Mph^*, and Gerardo Martinelli, MD, Mph^*

From the Department of Anesthesiology, *University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.

Address correspondence and reprint requests to Emanuele Piraccini, Department of Anesthesiology, S.Orsola-Malpighi Hospital, via Massarenti 9, 40137 Bologna, Italy. Address e-mail to dremanuelepiraccini{at}yahoo.it.

Opioids can induce central sensitization and hyperalgesia, referred to as "opioid-induced hyperalgesia." Our report describes a patient who underwent intestinal transplant followed by immunosuppressant-related neuropathic pain. Her pain was treated with limited success over the course of 3 yr with different therapies, including IV morphine. She developed opioid-induced hyperalgesia, which was successfully treated with rapid detoxification under general anesthesia. Detoxification improved her quality of life, including the ability to resume physiotherapy. Six months after treatment, she remained opioid free. Our experience suggests that rapid detoxification under general anesthesia may be an effective treatment for opioid-induced hyperalgesia and merits comparison to traditional detoxification methods.