| Abstract: |
A 46-year-old woman with metastatic ovarian cancer was admitted to the palliative care service for pain control. The patient had been diagnosed 5 years earlier during a work-up of an adnexal mass that was found to be a papillary serous adenocarcinoma of the ovary, stage IIIA. This case presents the challenging syndrome of opioidrelated myoclonus (ORM). Myoclonus describes involuntary, sudden, shock or jerk-like muscular contractions, usually of the extremities and head. In this case of far advanced cancer, myoclonus developed after the patient was given high-dose hydromorphone, improving only briefly with dose reduction and the addition of methadone and clonazepam. An alternative initial strategy would have been to completely discontinue the hydromorphone, as continuing even reduced doses of hydromorphone may have been sufficient to perpetuate the myoclonus and instead use intravenous fentanyl or methadone as the sole opioid. In our experience, some cases can be resolved with this approach while maintaining normal mentation. However, in other cases, when trying to balance the risks and benefits of further opioid drug/dose manipulations against the degree of current and expected future patient suffering, and a very limited prognosis, the decision to provide sedation is very appropriate. Cases such as this require the full involvement from interdisciplinary pain and palliative care professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved). |
