Successful pain control in a patient with a desmoid tumor complicated by having selected the medicine considering the pharmacokinetic of the opioid
10.2512/jspm.8.511
- VernacularTitle:薬物動態を考慮して薬剤を選択したオピオイドによって疼痛管理が可能となった短腸症候群合併デスモイド腫瘍の1例
- Author:
Masayuki Sato
;
Tadashi Miyamori
;
Yukari Hattori
;
Junko Koyanagi
;
Shohei Saka
;
Jutarou Murase
;
Noburou Ishii
;
Tomohiro Nishi
;
Tadashi Yamagishi
- Publication Type:Journal Article
- Keywords:
short bowel syndrome;
opioid;
palliative care;
desmoid tumor
- From:Palliative Care Research
2013;8(1):511-514
- CountryJapan
- Language:Japanese
-
Abstract:
Case: The patient was a man in his 40s who had undergone proctocolectomy for familial polyposis coli and extensive resection of the small intestine for removal of an intra-abdominal desmoid tumor. He presented to our hospital with abdominal pain caused by residual desmoid tumor, and diarrhea associated with the short bowel syndrome. Adequate pain control could not be achieved even with simultaneous application of 5 sheets of 100 μg/h transdermal fentanyl patches. Subsequently, the patient was treated mainly with 270 mg/day of a slow-release morphine preparation; however, the pain control remained unsatisfactory. At our hospital, the pain treatment was switched to 240 mg/day of morphine solution, which yielded prompt reduction of the pain intensity from 9/10 to 1/10 on the numerical rating scale. Discussion: Morphine is mainly absorbed from the small intestine. The initially insufficient pain control in this patient may have been attributable to the short bowel syndrome and diarrhea causing rapid excretion of the morphine before it was absorbed. Morphine solution, in contrast, starts to be absorbed approximately 10 minutes after administration, allowing adequate absorption, leading to successful pain control, even in the present patient with the short bowel syndrome.
