A Case of Withdrawal Syndrome after Opioid Discontinuation Following Pain Relief of Bone Metastases

Ayaka Ishikawa; Sayaka Arakawa; Hiroto Ishiki; Koji Amano; Yuka Suzuki; Nami Ikenaga; Shun Yamamoto; Tairo Kashihara; Tetsuhiko Yoshida; Eriko Satomi

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A Case of Withdrawal Syndrome after Opioid Discontinuation Following Pain Relief of Bone Metastases

VernacularTitle:緩和的放射線治療とメサドンによるがん疼痛緩和後にオピオイド中止により離脱症状を呈した1例
Author: Ayaka ISHIKAWA ¹ ; Sayaka ARAKAWA ¹ ; Hiroto ISHIKI ¹ ; Koji AMANO ¹ ; Yuka SUZUKI ¹ ; Nami IKENAGA ² ; Shun YAMAMOTO ³ ; Tairo KASHIHARA ⁴ ; Tetsuhiko YOSHIDA ⁵ ; Eriko SATOMI ⁶
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1. Department of Palliative Medicine, National Cancer Center Hospital
2. Department of Gastroenterology and Hepatology, Tokyo Medical University
3. Department of Nursing, National Cancer Center Hospital
4. Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital
5. Department of Radiation Oncology, National Cancer Center Hospital
6. Fukuro Clinic Todoroki
Keywords: opioid withdrawal syndrome; oxycodone; methadone
From:Palliative Care Research 2023;18(3):159-163
CountryJapan
Language:Japanese
Abstract: Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.