Use of gabapentin was effective to improve cancer pain associated with extensive collapse of upper cervical vertebrae due to multiple myeloma: a case report

Abstract

Purpose: Some patients with cancer pain are relatively less responsible to opioids, and require other strategies to improve the balance between analgesia and adverse effects. In those patients, the usage of some adjuvant analgesic drugs is recommended with opioid analgesics according to the first step of the WHO ladder for cancer pain relief. Recently, the efficacy of gabapentin for several cancer-related neuropathic pain has been reported. Case report: We present the case of a 64-years old female patient who had extensive vertebral bone destruction of C1-C2 due to metastasis of multiple myeloma, complicated with acute tetraplegia. Invasion to the retropharyngeal space by tumor enlargement seemed to increase the risk of upper airway obstruction. When our palliative care team first met her, she was suffering from the severe nape pain with allodynia at her right shoulder and incurable headache, refractory to intravenous morphine hydrochloride administration of 100mg/day (numerical rating scale; NRS 7/10). Her chief physician was negative against the dose escalation of the opioid analgesics, because of the risk of respiratory depression. Significant analgesic effect (NRS 3/10) was immediately achieved with oral gabapentin 900mg/day on day1. On day5, after gabapentin was increased up to 1,800mg/day, her nape pain was remarkably reduced to NRS 1/10, and no adverse effect was reported. Conclusion: For patients who are relatively naïve to increase of opioid analgesics, the supplementary use of adjuvant analgesic drugs would be favorable to both objectives; fewer adverse effects and reduction of the pain. Palliat Care Res 2009; 4(1): 301-306