• Robert Maksymowicz, Cyprian N Strączek, Jeremi J Matysek, Dominika M Lech, and Krzysztof Nosek.
• Department of Pharmacology and Toxicology Center for Experimental Medicine, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland.
• Medicine (Baltimore). 2024 Aug 2; 103 (31): e39126e39126.

RationaleDiabetic neuropathy is a prevalent and debilitating complication of diabetes, necessitating effective pain management strategies. While pharmacological treatments, including opioids, are commonly employed, they pose significant challenges due to the risk of developing opioid-induced hyperalgesia (OIH). This case report aims to illustrate the efficacy of a comprehensive, multidisciplinary approach in managing painful diabetic neuropathy complicated by OIH.Patient ConcernsA 64-year-old male patient presented to the Pain Treatment Clinic with severe lower limb pain due to diabetic polyneuropathy. He had a history of multiple comorbidities.DiagnosesThe patient's condition and physical examination suggested the presence of opioid-induced hyperalgesia (OIH). Despite the increased dose of opioids, the patient did not report significant constipation or breathing difficulties but experienced drowsiness and dry mouth. A diagnosis of opioid and benzodiazepine dependence was made.InterventionsThe treatment plan involved the initiation of pregabalin and duloxetine, gradual reduction of opioid use, and psychiatric support for addiction management.OutcomesOver 12 months, the patient experienced significant pain reduction and minimal adverse effects.LessonsEffective management of OIH involves gradual opioid tapering and a multimodal therapeutic approach. However, the optimal treatment strategies and the frequency of OIH occurrence remain areas of uncertainty, relying heavily on clinical expertise and individualized patient care. Further research is needed to refine these treatment strategies and improve patient outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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