2019 Volume 26 Issue 1 Pages 48-52
A 42-year-old woman with type 1 diabetes, initially admitted to the hospital for the management of ischemic gangrene, received almost daily injections of buprenorphine for associated right foot pain. Subsequently, she underwent off-pump coronary artery bypass graft (CABG) surgery and received pentazocine for post-thoracotomy pain. After several months she was referred to our pain clinic, as she not only had severe pain but also firm expectations for the continued administration of buprenorphine and pentazocine injections. She was therefore diagnosed with opioid dependence. We recommended a transition to oral tramadol and pregabalin. When a fentanyl patch was introduced for the withdrawal symptoms, they disappeared the following day. Following this, we adjusted the prescribed medications for about six weeks, after which she was discharged home. In this case, we strongly suspect an opioid pseudoaddiction through the treatment progress. Furthermore, we propose that fentanyl, which is a pure μ receptor agonist and offers a more stable blood level as a patch, is an effective and safe therapeutic agent for opioid-dependent patients in Japan with limited therapeutic options.
