Opioid Hypermetabolism in a Multiextremity Spine Trauma Patient: A Case Report.

Creator(s)

Stephen Fanous, Children's Mercy Kansas CityFollow
Zach Denton
Nicolette Saddler, Children's Mercy Kansas CityFollow
Anne Stuedemann, Children's Mercy Kansas CityFollow
John Anderson, Children's Mercy HospitalFollow
K Aaron Shaw, Children's Mercy Kansas CityFollow

Document Type

Article

Publication Date

12-4-2025

Identifier

DOI: 10.2106/JBJS.CC.25.00430

Abstract

CASE: A 17-year-old man presented with an unstable C5 flexion-compression injury and bilateral comminuted distal radius fractures after a motorcycle collision. Despite standard opioid therapy, he experienced difficulty with pain control during and after treatment. Genetic testing revealed a polymorphism in the cytochrome P450 2D6 (CYP2D6) gene, resulting in ultrarapid metabolism.

CONCLUSION: Genetic mutations in CYP2D6 can result in impaired opioid metabolism and impaired pain control. Impaired pain control in musculoskeletal trauma patients should raise concern for a potential CYP2D6 mutation. A proper understanding of this condition and adjustments in pain management can guide optimal care for these patients.

Journal Title

JBJS Case Connect

Volume

15

Issue

4

MeSH Keywords

Humans; Male; Adolescent; Analgesics, Opioid; Cytochrome P-450 CYP2D6; Radius Fractures; Cervical Vertebrae; Accidents, Traffic; Spinal Injuries

PubMed ID

41343619

Keywords

CYP2D6 polymorphism; adolescent; inadequate pain control; methadone; multitrauma; musculoskeletal trauma; opioid hypermetabolism; opioid resistance; pain; pharmacogenomics; postoperative pain; spine trauma

Recommended Citation

Fanous S, Denton Z, Saddler N, Stuedemann A, Anderson JT, Shaw KA. Opioid Hypermetabolism in a Multiextremity Spine Trauma Patient: A Case Report. JBJS Case Connect. 2025;15(4):e25.00430. Published 2025 Dec 4. doi:10.2106/JBJS.CC.25.00430