Morphine
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Various side effects: case report A 42-year-old woman developed general numbness, decreased limb muscle strength, uroschesis, nausea, emesis, pruritus, vomiting and lethargy during treatment with while receiving treatment with morphine for cancerous pain (headache) [not all durations of treatments to reactions onsets stated]. The woman, was diagnosed with metastatic peripheral lung adenocarcinoma in May 2017. Thereafter, she had received multiple chemotherapeutic drugs. From March 2018, she started complaining of head distension and ache. In October 2018, she was diagnosed with meningeal metastases. In March 2019, she was admitted with an aggravation of headache symptom. She had received various symptomatic treatments like osimertinib, dehydration, hormone, intrathecal injection chemotherapy, but showed poor curative effects. Therefore, she was considered to have severe cancerous pain (headache) and started receiving treatment with morphine on 12 March 2019. She received hypodermic injection of morphine 5mg on day 1. The doses of morphine extendedrelease tablets were adjusted based on the doses of the morphine immediate-release tablets required to relieve breakthrough pain (BTP) occurring in the initial 24 hours. On day 6 of treatment, the dosage of morphine extended-release tablet reached 660mg (330mg every 12 hours). Meanwhile, she developed morphine-induced side effects like general numbness, uroschesis, decreased limb muscle strength, pruritus, nausea and emesis. To achieve pain relief by alleviating increased intracranial pressure, she was treated with anticancer therapy for 1 week. At that time, she was receiving oral morphine 30mg for 1 week to relieve breakthrough pain, which made her morphine-tolerant patient. While received oral morphine, she had developed frequent vomiting, which led to an inaccuracy in oral morphine intake. Therefore, in order to maintain a stable plasma concentration, to reduce adverse effects of oral morphine and maximize pain relief, the woman started receiving IV morphine 240 mg/day via infusion pump from day 22. The doses of morphine were dynamically adjusted. On day 28, the dose of morphine reached to 480 mg/day. The cancerous pain was significantly relieved, without BTP. On day 42, she developed lethargy with mild nausea due to morphine. Given the unmanageable adverse effects and partially relieved cancerous pain, morphine dose reduction was considered to alleviate the adverse effects. Therefore, the dose of morphine was reduced once every 2 days from day 43. By day 71, the dose of morphine was IV 10 mg/day infusion. This dose was continued for 2 days and then withdrawn on day 73. No withdrawal symptoms were observed. During re-evaluation she showed increased limb muscle strength and no BTP had occurred. She had began routine anticancer treatment [not all outcomes stated]. Zhang X, et al. Intravenous analgesia with ultra-high-dose morphine for the treatment of headache and successful withdrawal of morphine: A case report and literature review. 803517781 Medicine 99: No. 44,
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