AI Article Synopsis
- A 76-year-old woman with chronic pain and an implanted pain pump was admitted due to heart failure, complicating her pain management.
- She could not tolerate oral opioids and experienced withdrawal symptoms after tapering her hydromorphone, indicating physical dependence.
- A new approach using microdosing sublingual buprenorphine-naloxone allowed her to safely decrease hydromorphone use while managing her pain and avoiding withdrawal issues.
Article Abstract
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone-bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine-naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.
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| http://dx.doi.org/10.1213/XAA.0000000000001316 | DOI Listing |
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