Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomidine and Morphine: A Case Report

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.

Emergency Palliative Cancer Care: Dexmedetomidine Treatment Experiences—A Retrospective Brief Report on Nine Consecutive Cases

“…These findings are consistent with our results, where five out of seven patients with severe cancer pain described pain relief. In a case report on successful treatment of cancer pain and depression with intrathecal administration of dexmedetomidine and morphine, also significantly reduced symptom scores for anxiety and drowsiness were reported [29]. These data are congruent with our observations of reduced anxiety and acceptable side effects.…”

“…The treatment in our study was initiated and monitored by anesthesiologists. Previous papers have described the safe use of dexmedetomidine in palliative care patients [9,29,39]. However, potential safety issues include the risk for bradycardia, arrhythmias, and both hyper-and hypotension [25].…”

“…However, the evidence base for its use in this group of patients is still limited [26]. For adults, case reports described symptom relief in patients with severe cancer pain and anxiety, and anecdotal papers reported positive effects on various symptoms like delirium, dyspnea, vomiting, and depression [8][9][10][27][28][29][30][31]. In terminally ill children, a recent systematic review, based on retrospective evidence, found dexmedetomidine for pain control to be significantly associated with improved quality of life [32].…”

Influencing factors of depressive symptoms in patients with malignant tumour

“… 31 Studies have shown that pain substantially affects the psychology of patients, and moderate to severe pain leads to severe depressive symptoms in patients. 32 The present findings showed that pain increased the risk of patient depressive symptoms by 0.973 times, indicating that pain is an independent risk factor for depressive symptoms in patients with malignant tumours. Patients experiencing pain may have inflammation, which is associated with a high risk of depression because inflammation can induce neurogenesis and synaptic plasticity impairment.…”

Biased, Bitopic, Opioid–Adrenergic Tethered Compounds May Improve Specificity, Lower Dosage and Enhance Agonist or Antagonist Function with Reduced Risk of Tolerance and Addiction

“…Notably, an adrenergic α(2C)-agonism/α(2A)-antagonism combination has proven to be particularly effective at preventing opioid dependence [44], suggesting that both agonists and antagonists may play important roles as enhancers of opioid therapy. An additional benefit of opioid-adrenergic agonist combinations is that the adrenergic agonist can reverse acute opioid tolerance, an effect established in both animal models and in the clinic [35,41,43,[45][46][47][48].…”