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• W2059152092 abstract "A38-YEAR-OLD PHILIPPINA WOMAN was admitted to an inpatient hospice unit with severe pain. She was a poor historian. She described the pain as shooting from her left hip radiating down the lateral aspect of her left leg to her left great toe. The pain was episodic. At times, she only felt slight burning in her great toe; at other times she screamed in pain and gripped the side rail of the bed. The pain had been growing worse and more frequent for several days prior to admission. She had previously been treated with morphine, fentanyl, and oxycodone with incomplete relief. The patient had stage II (T2 N0 M0) breast cancer that had been diagnosed 7 years prior to admission. This had been treated with lumpectomy and radiation. Six years ago, metastases to lung, lumbar, and thoracic spine were treated with radiation followed by chemotherapy. Two years prior to admission she developed cognitive changes as a result of a large frontal mass. This mass was resected and found to be adenocarcinoma consistent with primary breast cancer. The patient subsequently was treated with whole brain radiation. She had significant short-term memory loss. For the past 6 months she had been cared for in a nursing home because she was unable to care for herself. She had been receiving hospice care for 3 months. She had never married and had no children. Her brother was essentially living with her in the nursing home. Her mother lived in the Philippines. Physical examination at admission showed a cushingoid appearance attributed to long-term corticosteroid use. Her vital signs were normal. Although she understood some English, she could not or would not understand some directions or questions. She seemed regressed and childlike. The patient was noted to report mild burning pain in her left great toe of 2 on a scale of 1 to 10. At times she was unable to answer questions about pain because of her distress. Some observers noted that the periods of pain-related behaviors (i.e., crying and sobbing or gripping the bed rails) were particularly dramatic when family was present; others did not observe this pattern. Serum electrolyte levels were normal. Complete blood count showed no evidence of infection. A roentgenogram of the abdomen showed moderate constipation. Further imaging studies were not performed. Suspected carcinomatous meningitis with seeding of the L4-L5 nerve routes might have been responsible for her pain syndrome and mental status. The hydromorphone dose was increased to 12 mg/hr subcutaneously. Further dose escalation was limited by myoclonus. Dexamethasone, 40 mg/d, was administered. Infusional lidocaine was ineffective. Oral methadone had no additional benefit. She continued to receive the following: gabapentin, 1200 mg orally three times per day; carbamazepine, 200 mg orally, twice per day; phenytoin, 300 mg orally each day; and desipramine, 50 mg orally each day. The patient began having difficulty swallowing medications so ketamine was suggested." @default.
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• W2059152092 date "2003-06-01" @default.
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• W2059152092 title "Ketamine to Control Pain" @default.
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• W2059152092 doi "https://doi.org/10.1089/109662103322144808" @default.
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