Reactions 1704, p242 - 2 Jun 2018
Cognitive dysfunction: case report
A 58-year-old man developed cognitive dysfunction while
receiving methadone and oxycodone [duration of treatment to
reaction onset not stated].
The man, who was diagnosed with amyloid-associated
peripheral neuropathy, started receiving treatment with oral
methadone 40 mg 4 times daily along with several other
medications for neuropathic pain. The treatment with
methadone showed good response but the dose was not
increased due to cognitive dysfunction, which had intensified
with methadone treatment. Additionally, he also received oral
oxycodone 80mg every 4
6 hours daily for breakthrough pain.
Afterwards, he started receiving intrathecal hydromorphone.
To avoid over-sedation, the dose of methadone was reduced to
10mg 2 times a day, while oxycodone was continued at a dose
20 mg every 4 hours.
The man was admitted for close monitoring of his pain. At
the time of discharge, his methadone dose was reduced to
5mg 2 times daily while oxycodone was reduced by 25% in his
daily usage. Subsequently, his cognitive function improved
after reduced dependence on oral opioids.
Author comment: "High-dose oral opioid therapy was
only modestly successful in analgesic efficacy and was
associated with substantial unwelcome effects including
alterations in cognition."
Warner NS, et al. Refractory Pain Management in Amyloid-Associated Peripheral
Neuropathy. Regional Anesthesia and Pain Medicine 43: 434-437, No. 4, May
2018. Available from: URL: http://doi.org/10.1097/AAP.0000000000000733 -
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved