Opioid rotation in cancer related “mixed pain” scenario: How a “chronic pain patient” becomes a “palliative patient”—a case report

Abstract

This case report describes the situation of a 67-year-old chronic pain patient who is confronted with the diagnosis of metastatic small cell lung cancer due to an incidental finding. Previously, she had been struggling with chronic lumboischialgia. As she progressed, treatment-resistant tumor pain became increasingly prominent. The importance of recognizing the change in pain quality is described. The tumor pain with a neuropathic component or “mixed pain” made symptom control difficult in the present case report. A switch from transdermally applied fentanyl to a subcutaneous perfusor system with morphine was made and shortly thereafter, due to lack of pain control, to an oral sustained-release oxycodone preparation. This dual opioid rotation is discussed below. Aspects such as resistance development, incomplete cross-tolerance and genetic polymorphisms are highlighted with the help of scientific literature review.