A 55-year-old man with a history
of lung cancer, liver metastasis, a liver abscess, and glomerulonephritis
(RPGN) associated with methicillin-resistant Staphylococcus aureus (MRSA)
infection presented at our department. He underwent a right upper lobectomy,
with resection of the parietal pleura, for right lung cancer. He had a
recurrence of the cancer, liver metastasis, and a liver abscess
postoperatively, and was treated via a left hepatic lobectomy for the
metastastic liver tumor. Oxycodone (Oxycontin®; 80 mg/day) was used to treat severe
pain in his right chest.
He didn’t receive drugs which
influence the metabolism of oxycodone such as CYP3A4 and CYP2D6 inhibitors and
inducers. Elevated serum creatinine, proteinuria, and hematuria indicated glomerulonephritis-induced
renal failure. He then presented at our department for pain control during
hemodialysis.He presented to us with pain in his right chest, right back, and
right arm. The right chest and back pain were intermittent sharp pains, and
localized in his right precordia and around his scapula.
The maximum, minimum, and average
pain scores based on the 0–10 numeric rating scale (NRS) were 4/10, 2/10 and
2/10 respectively. Neither neurological disturbances, hypaesthesia, nor
listlessness was identified, and the douleur neuropathique 4 questions (DN4)
score was a 0/10. We therefore diagnosed these right chest and back pains as
somatalgia. However, the right arm pain was continuous and intermittent,
relatively sharp, and localized in the area supplied by the ulnar nerve. No
shooting pain was identified.
No comments:
Post a Comment