title: Severe opioid toxicity and somatization of psychosocial distress in a cancer patient with a background of chemical dependence.
abstract: A case of severe opioid toxicity is described in a 52-year-old cancer patient. The patient presented with classical clinical features of central hyperexcitability associated with opioid toxicity: delirium, myoclonus, hallucinations, hyperalgesia, and a possible seizure. This patient had a background of severe psychosocial distress and somatization in addition to a history of benzodiazepine dependence and alcohol abuse. The occurrence of opioid toxicity in this patient highlights the risks of a unidimensional approach to cancer pain, which ignores the non-organic components of pain, such as psychosocial distress, which will not respond to escalating doses of opioid medication.
authors.affiliation: Palliative Care Program, Grey Nuns Community Health Centre, Edmonton, Alberta, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Lawlor
authors.forename: P
authors.initials: P
authors.lastname: Walker
authors.forename: E
authors.initials: E
authors.lastname: Bruera
authors.forename: S
authors.initials: S
authors.lastname: Mitchell
mesh_terms: D000437:Alcoholism / Q000150:complications*; D000701:Analgesics, Opioid / Q000506:poisoning* / Q000627:therapeutic use; D001569:Benzodiazepines; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D009020:Morphine / Q000506:poisoning* / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D011605:Psychoses, Substance-Induced / Q000175:diagnosis* / Q000503:physiopathology; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D009020:Morphine