Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomid
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CASE REPORT
Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomidine and Morphine: A Case Report Ge Huang . Guo Liu . Zhiguo Zhou . Jinfeng Yang . Chen Su
Received: May 26, 2020 Ó The Author(s) 2020
ABSTRACT Patients who have refractory cancer pain suffer both physically and psychologically. Cancer pain management has improved over the past few decades. However, the treatment of refractory cancer pain is still challenging all over the world. Intraspinal analgesia has become an effective strategy to treat refractory pain in patients with cancer. In this report, we present a patient receiving a large dose of intrathecal opioids for refractory cancer pain, and who is also afflicted with pain-induced depression. Dexmedetomidine (DEX) was used as part of a multimodal analgesic regimen that successfully alleviated both the patient’s pain and depression. An intrathecal infusion of DEX may serve as an adjuvant drug in the treatment of cancer pain and pain-related depression.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12582596. G. Huang G. Liu Z. Zhou J. Yang C. Su (&) Department of Anesthesiology and Pain Medicine, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, China e-mail: [email protected] G. Huang University of South China, Hengyang 421001, Hunan, China
Keywords: Depression; Dexmedetomidine; Intrathecal analgesia; Refractory cancer pain Key Summary Points Why carry out this study? A few studies reported that emotion disorder, like depression, is pretty common in patients with cancer pain, and this patient had depressive symptoms with unrelieved severe pain. This case showed that coadministration of DEX and morphine intrathecally is an effective and safe way to treat refractory cancer pain in the patient. Intrathecal administration of DEX has alleviated depressive behaviors of this patient and it therefore might have antidepressive properties. What was learned from this study? This case provides evidence that the multimodal pain management with DEX participation could be an effective and safe treatment strategy for refractory cancer pain and pain-related depression. Refractory cancer pain and accompanying depression deserve more attention and intervention to deliver better management both physically and psychologically.
Pain Ther
INTRODUCTION Pain is one of the most prevalent symptoms in patients with advanced cancer [1]. Cancer pain can be effectively treated in most patients by following the guidelines of the three-step analgesic ladder [2]. In spite of aggressive treatment, 10–15% of patients with cancer still suffer from refractory cancer pain [3]. Prolonged pain can significantly affect patients, not only in terms of physical suffering but also mental anguish, which can produce depression in up to 20% of patients with cancer [4]. Depression itself leads to additional emotional and cognitive deficits, further impairing
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