Improvement in quality of life using fentanyl patch together with mirtazapine following transition from pentazocine and buprenorphine due to pseudo-addiction: a case report

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  • TAKEMURA Yoshinori
    Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
  • AOKI Yuta
    Department of Anesthesiology, Saiseikai Toyama Hospital
  • ITO Hisakatsu
    Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama
  • HORIKAWA Hideyo
    Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama
  • HATTORI Mizuki
    Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama
  • YAMAZAKI Mitsuaki
    Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama

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Other Title
  • ペンタゾシンおよびブプレノルフィン注射薬連用による偽依存から，フェンタニル貼付薬へのオピオイドスイッチングとミルタザピン内服薬併用により自宅退院に至った症例
  • 症例 ペンタゾシンおよびブプレノルフィン注射薬連用による偽依存から,フェンタニル貼付薬へのオピオイドスイッチングとミルタザピン内服薬併用により自宅退院に至った症例
  • ショウレイ ペンタゾシン オヨビ ブプレノルフィン チュウシャヤク レンヨウ ニ ヨル ニセ イソン カラ,フェンタニル ハリツケヤク エ ノ オピオイドスイッチング ト ミルタザピン ナイフクヤク ヘイヨウ ニ ヨリ ジタク タイイン ニ イタッタ ショウレイ

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<p>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.</p>

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