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Managing breakthrough pain for advanced malignancy in elderly patients: A real challenge

Deepti Ahuja, MD, Nandan Choudhary, MD, Vinod Kumar, MD, Nishkarsh Gupta, MD, Sachidanand Jee Bharati, DM


Pain management in advanced cancer patients using opioids like morphine is challenging due to presence of predisposing factors like renal insufficiency, hepatic insufficiency, hypoproteinemia, hypoalbuminemia, and anemia that can easily precipitate inadvertent toxic effects. We report a case morphine toxicity in an elderly patient of lung cancer with concomitant presence of chronic obstructive pulmonary disease (COPD) and recent onset renal impairment. Opioid analgesic overdose is a lethal but at the same time, a preventable and treatable condition. We managed the case using naloxone infusion. However, we emphasize early anticipation and recognition of predisposing factors followed by timely intervention to manage this life-threatening condition.


elderly, lung cancer, COPD, renal impairment, hypoproteinemia, opioid, toxicity, naloxone

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