Background:
Opioids are considered an effective method for acute and chronic pain management, but they are not suitable for all cases and should be used in carefully selected patients. In the past several decades, their use has come under intense scrutiny due to significant deviations from the classically described applicability of opioids in cancer-related pain.
Case Description:
A 34-year-old female with a 6-year history of worsening neck pain and suboccipital headaches was managed medically including the use of oral muscle relaxants, steroids, gabapentin, and opioid-based medications as well as interventional pain procedures that provided only temporary pain relief. She made repeated ER visits and had multiple hospital admissions for pain control, during which times she was placed on patient-controlled analgesia with IV hydromorphone administration. During the most recent admission for an acute exacerbation of chronic pain, she was found by her mother to be unresponsive and not breathing. A code blue was called and cardiopulmonary resuscitation per an advanced cardiac life support algorithm was conducted. The patient was successfully resuscitated and was discharged from the hospital in satisfactory condition. This incident was reported as an “allergic reaction” to hydromorphone. After consultation with a neurosurgeon, the patient underwent a definitive surgical intervention consisting of a C5–6 anterior cervical discectomy and fusion using an interbody spacer and anterior instrumentation. Within 6 weeks, she reported significant decreases in her pain, stopped using the pain medication, and was able to return to her normal lifestyle.
Conclusions:
The present case report is an example of long-term pain management with multiple medications, including opioid use and performing interventional pain procedures, while avoiding early surgical correction of cervical disc herniation. This resulted in years of suffering with pain and serious morbidity from opioid overdosing. Surgical intervention was definitive in terms of ultimately improving her pain and reducing her reliance on opioid analgesics.
Refractory Schizophrenia, Attempted Suicide, and Withdrawal of Life Support: A Clinical Ethics Case Report