We describe an interesting case of opioid unresponsive- ness, showing the importance of clinical history, inte- grated with pharmacokinetic and pharmacogenomic analysis, to shed light on mechanisms of abnormal response to opioid analgesics and provide clinicians with strategies to overcome opioid resistance. A 71- year-old woman (height 1.55 m, weight 48 kg) of Italian Slovene descent with endometrial carcinoma (staging pT3aN1Mx IIIC), who refused adjuvant chemotherapy and radiotherapy, showed a high bone, spinal, pelvic pain numerical rating scale (NRS) score of 9–10, with initial good benefits from high-dose (100mg daily) mor- phine subcutaneous pump; given the scarcity of subcu- taneous tissue, as an alternative administration route, oral controlled-release morphine plus fentanyl trans- dermal therapeutic system (TTS) was selected.

Opioid Resistance Associated with CYP3A4 Hyperactivity and COMT Polymorphism in an Oncological Patient

Murrone, Antonio;Borotto, Gianluca;Favretto, Diego;Candussio, Luigi;Malusà, Noelia;d'Adamo, Pio;Decorti, Giuliana;Stocco, Gabriele
2018-01-01

Abstract

We describe an interesting case of opioid unresponsive- ness, showing the importance of clinical history, inte- grated with pharmacokinetic and pharmacogenomic analysis, to shed light on mechanisms of abnormal response to opioid analgesics and provide clinicians with strategies to overcome opioid resistance. A 71- year-old woman (height 1.55 m, weight 48 kg) of Italian Slovene descent with endometrial carcinoma (staging pT3aN1Mx IIIC), who refused adjuvant chemotherapy and radiotherapy, showed a high bone, spinal, pelvic pain numerical rating scale (NRS) score of 9–10, with initial good benefits from high-dose (100mg daily) mor- phine subcutaneous pump; given the scarcity of subcu- taneous tissue, as an alternative administration route, oral controlled-release morphine plus fentanyl trans- dermal therapeutic system (TTS) was selected.
2018
19-lug-2017
Pubblicato
https://academic.oup.com/painmedicine/article/19/3/638/4056220
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2919903
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