{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:22:35Z","timestamp":1766514155000},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,30]],"date-time":"2019-11-30T00:00:00Z","timestamp":1575072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,30]],"date-time":"2019-11-30T00:00:00Z","timestamp":1575072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Chemical coping is an inappropriate method for dealing with stress through the use of opioids; it is considered the stage prior to abuse and dependence. In patients with cancer, it is important to evaluate the risk of chemical coping when using opioids. There are some pediatric opioid use-related tolerances and addictions; however, no mention of chemical coping has been found.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>We present a case of an 11-year-old Japanese boy with acute lymphocytic leukemia. After transplantation, he complained of abdominal and articular pain, which are considered as symptoms of graft-versus-host disease; thus, opioid therapy was initiated, and the dose was gradually increased for pain management, resulting in a high dose of 2700\u2009\u03bcg\/day of fentanyl (4200\u20134700\u2009\u03bcg\/day including the rescue dose). After switching from fentanyl to oxycodone injections, he continued to experience pain, and there was no change in the frequency of oxycodone rescue doses. Physically, his pain was considered to have alleviated; thus, there was the possibility of mental anxiety resulting in the lowering of pain threshold and the possibility of chemical coping. Mental anxiety and stress with progress through schooling was believed to have resulted in chemical coping; thus, efforts were made to reduce the boy\u2019s anxiety, and opioid education was provided. However, dose reduction was challenging. Ultimately, with guidance from medical care providers, the opioid dose was reduced, and the patient was successfully weaned off opioids.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>When chemical coping is suspected in pediatric patients, after differentiating from pseudo-addiction, it might be necessary to restrict the prescription for appropriate use and to provide opioid education while taking into consideration the emotional background of the patient that led to chemical coping.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-019-2273-7","type":"journal-article","created":{"date-parts":[[2019,11,30]],"date-time":"2019-11-30T01:02:23Z","timestamp":1575075743000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A pediatric cancer patient with suspected chemical coping following high-dose opioid therapy: a case report"],"prefix":"10.1186","volume":"13","author":[{"given":"Mototsugu","family":"Miura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenkichi","family":"Tsuruga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Morimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,30]]},"reference":[{"key":"2273_CR1","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/0885-3924(95)00084-4","volume":"10","author":"E Bruera","year":"1995","unstructured":"Bruera E, Moyano J, Seifert L, Fainsinger RL, Hanson J, Suarez-Almazor M. The frequency of alcoholism among patients with pain due to terminal cancer. J Pain Symptom Manag. 1995;10:599\u2013603.","journal-title":"J Pain Symptom Manag"},{"key":"2273_CR2","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1200\/JCO.2013.52.5170","volume":"32","author":"ED Fabbro","year":"2014","unstructured":"Fabbro ED. Assessment and management of chemical coping in patients with cancer. J Clin Oncol. 2014;32:1734\u20138.","journal-title":"J Clin Oncol"},{"key":"2273_CR3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.25011\/cim.v30i1.447","volume":"30","author":"S Dhalla","year":"2007","unstructured":"Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"353"}}