case_images: PMC10556467_01
case_images: Timeline depicting the clinical history of the patient (in purple) and pain management (in green). On the right: osteolytic lesion of the posterior portion of thoracic vertebra (D10). Panel (A-C) Axial plane; panel (D) sagittal plane.
case_images: fpain-04-1256809-g001.jpg
case_images: PMC10556467_01_fpain-04-1256809-g001.jpg
case_images: F1
case_images: In February 2019 she reported back pain (Numeric Pain Rating Scale, NPRS 8/10), therefore she underwent a total spine CT scan with evidence of an osteolytic lesion of the posterior portion of D10 (depicted in Figure 1) that extended, without involvement, to the spinal cord. The back pain due to osteolytic lesion was unresponsive to NSAIDs, therefore she started oxycodone 10 mg BID and gabapentin 300 mg BID from May 2019 (the timeline of the treatment is depicted in Figure 1).
case_images: Balance among opioid tolerance and addiction. On the one hand we have the physiological mechanisms of tolerance and physical dependence on opioid. On the other hand, the alarm bells that every doctor must keep in mind during pain-relieving therapy with opioid. Not paying adequate attention to the risk factors which, even in the patient with cancer, can lead to addiction, causes the balance between the two aspects of opioid therapy to become unbalanced. A careful anamnesis and the close monitoring of the patient, allows the physician to keep the two pans of the scales in balance, obtaining the maximum pain response and minimizing the risks. Created with BioRender.com.
case_images: fpain-04-1256809-g002.jpg
case_images: PMC10556467_01_fpain-04-1256809-g002.jpg
case_images: F2
case_images: Withdrawal syndrome is characterized by somatic and psychological symptoms. [reassumed in Figure 2].
case_images: The journey of opioid prescription. At first, before prescription, the physician has to do a thorough assessment of the patient and the social context. The prescription of the pain-relief therapy must follow the guidelines, considering the clinical characteristics of the patient and the localization of the disease. Also, radiotherapy and physical rehabilitation have to be considered. The psychological aspects and non-pharmacological therapies should not be underestimated. Equal attention must be given to the tapering of pain-relieving therapy: each step must be shared with the patient, who has to be carefully monitored and instructed on the symptoms that may appear (i.e., hypertension, tachycardia, sweating, palpitations, ...). A multidisciplinary path involving oncologists and pain specialists, shared with the patient, can significantly reduce the risk of developing OUD for the patient, especially in long survivors. Created with BioRender.com.
case_images: fpain-04-1256809-g003.jpg
case_images: PMC10556467_01_fpain-04-1256809-g003.jpg
case_images: F3
case_images: Deprescription integrates opioid management expertise from the prescribing schedule, to opioid therapy initiation, dose titration, to switching or discontinuation, as reassumed in Figure 3.