Reactions 1704, p161 - 2 Jun 2018 Opioid dependence: case report A 67-year-old woman developed opioid dependence during treatment with fentanyl for chronic back pain [duration of treatment to reaction onset not stated]. The woman had a history of chronic back pain due to multi- level prolapsed intervertebral discs, fibromyalgia, insomnia and depression. She was receiving fentanyl patch 200µg every 72 hours and clonazepam for the back pain for 12 years. She was referred to the Rheumatology for suspected spondyloarthropathy. However, the rheumatologic work-up was negative. On re-evaluation, she reported that she always had mind-racing, crying, agitation, irritability, insomnia and depression. An examination revealed that she had poor insight, was anxious, depressed and agitated. All her findings were consistent with mixed bipolar affective disorder. She also had generalised anxiety disorder. She was found to be hyper- focusing on her physical health and therefore was receiving high-dose fentanyl with clonazepam. Therefore, her bipolar affective disorder was treated with olanzapine and generalized anxiety disorder was treated with clonazepam [klonopin]. Within a period of one month after treating the bipolar affective disorder and generalized anxiety disorder, the woman was successfully liberated off of opioid. Author comment: "Chronic pain can mask or be a manifestation of underlying, undiagnosed mental illness. It is important for physicians to recognize and treat mental illness appropriately as this can potentially reduce inappropriate opioid use." "She has taken fentanyl patch 200[µg] Q72 hrs and clonazepam for her back pain for 12 years." Yushuvayev E, et al. Unraveling the enigma of mental illness for successful treatment of opioid dependence. Journal of the American Geriatrics Society 66 (Suppl. 2): S24, 2018. Available from: URL: http://doi.org/10.1111/jgs.15376 [abstract] - USA 803323223 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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