Discontinuing opioids in a safe way. Case report and recommendations for Palliative Care

Sohail Ahmed; Zbigniew Zylicz

Vol 7, No 4 (2008)

Case reports

Published online: 2008-10-21

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Discontinuing opioids in a safe way. Case report and recommendations for Palliative Care

Sohail Ahmed, Zbigniew Zylicz

Advances in Palliative Medicine 2008;7(4):175-178.

Vol 7, No 4 (2008)

Case reports

Published online: 2008-10-21

Abstract

Opioids are the mainstay of pain treatment in cancer. In the course of disease many patients will experience increase of pain intensity and hence need an increase of the opioid dose. However, in some situations, when for example the other treatment of pain is effective, the dose of opioids could and should be decreased or even discontinued. Many patients continue on the opioids because it is unclear how and when to discontinue them. We present the case of a patient treated for his pain with opioids. Opioids were responsible for vivid delirium, probably exacerbating subclinical dementia. Treatment with steroid injections allowed to decrease and later discontinuation of opioids with a clear gain in lucidity and cognitive functioning by the patient. We propose the guidelines how and when to wean patients from the opioids. Buprenorphine and clonidine, but possibly also gabapentin may play a role in the prevention and pharmacological treatment of the symptoms of abstinence.