Fentanyl-Induced Neurotoxicity and Paradoxic Pain

Abstract A patient with pain associated with metastatic leiomyosarcoma received escalating doses of opioids. Upon discontinuation of intravenous morphine, transdermal fentanyl was initiated, and after several days, the dose was increased to 200 μg/hour for persistent, severe pain. The patient became...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pain and symptom management 2008-03, Vol.35 (3), p.327-333
Main Authors: Okon, Tomasz R., MD, George, Mathews Lal, MD
Format: Article
Language:English
Subjects:
Aged
Analgesics, Opioid - adverse effects
Analgesics, Opioid - toxicity
Anesthesia & Perioperative Care
Biological and medical sciences
Cancer
Fatal Outcome
Female
fentanyl
Fentanyl - adverse effects
Fentanyl - toxicity
Humans
Hyperalgesia - chemically induced
Leiomyosarcoma - complications
Leiomyosarcoma - secondary
Medical sciences
neurotoxicity
Neurotoxicity Syndromes
opioid-induced hyperalgesia
Pain - chemically induced
Pain - drug therapy
Pain - etiology
Pain Medicine
Pharmacology. Drug treatments
Uterine Neoplasms - complications
Uterine Neoplasms - pathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract A patient with pain associated with metastatic leiomyosarcoma received escalating doses of opioids. Upon discontinuation of intravenous morphine, transdermal fentanyl was initiated, and after several days, the dose was increased to 200 μg/hour for persistent, severe pain. The patient became somnolent, and further dose adjustments and route change were carried out. She then exhibited severe allodynia, myoclonus, and delirium thereafter fentanyl was stopped. All symptoms resolved with discontinuation of fentanyl and subsequent introduction of a weak opioid. Pain was well controlled. Gradually increasing standard doses of fentanyl may lead to severe neurotoxicity, which may respond to opioid discontinuation and/or rotation. Vigilant scrutiny of all possible causes of apparent analgesic failure followed by consideration of opioid reduction and rotation is warranted in cases of neurotoxicity accompanying opioid treatment.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2007.04.023