How Much Is Too Much? Are Opioids Always the Answer to Pain?

A 28-year-old woman with homozygous sickle cell disease had numerous hospitalizations since childhood due to sickle cell pain crises. Her only other significant medical diagnoses were chronic eosinophilic pneumonitis and a history of deep venous thromboses in her extremities. Her pain was managed for the last several years by her primary care physician (PCP) with the use of increasing doses of numerous opioid medications including hydrocodone, hydromorphone, fentanyl, morphine, and methadone. In light of increasing hospitalizations related to difficulty in controlling her pain and her pulmonary disease, the option of hospice care was introduced by her PCP. The patient and her mother agreed to enter hospice and she was discharged from the hospital on morphine sulfate controlled release 120 mg/day, methadone 100 mg/day, hydromorphone 2 mg as needed every 4 hours, and Cymbalta 40 mg/day.