Treatment of two patients with chronic pain and drug dependence by psychotherapy in combination with nerve block

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  • TANAKA Akemi
    Department of Anesthesia, Chita City Hospital
  • TSUDA Takako
    Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences
  • TAKEUCHI Akinori
    Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences
  • SASANO Hiroshi
    Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences
  • MAEDA Mitsunobu
    Department of Anesthesia, Chita City Hospital

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Other Title
  • 慢性疼痛患者における薬物依存2症例の治療経験
  • ショウレイ マンセイ トウツウ カンジャ ニ オケル ヤクブツ イゾン 2 ショウレイ ノ チリョウ ケイケン

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Abstract

We report on 2 patients with chronic pain and drug dependence who were treated successfully.<br>A 38-year-old male who sustained a finger injury in a workplace accident suffered from stump pain and attacks of pain in the right hand associated with convulsions. After he was referred to this city hospital from the special hand surgery section of a university hospital, the pain attacks at night became more frequent. He was treated with injections of pentazosin by the doctors on night duty, and rapidly became dependent on analgesics. He was admitted to the hospital, and sympathetic nerve block was administered to control the chronic pain. Following the results of a drug challenge test, ketamine injection was used.<br>A 56-year-old male suffering from pain in the back and both lower limbs caused by failed back surgery had severe pain attacks associated with generalized convulsions. He frequently visited the hospital at night and received analgesic injections to stop the convulsions, and had remained dependent on drugs for over ten years. His past history indicated that he had sustained a whiplash injury in a traffic accident several years ago. Total spinal block was administered, and the pain caused by the whiplash injury was relieved.<br>While the sympathetic nerve block was continued, we also introduced psychotherapy for the treatment of drug-dependence condition. The cognitive behavioral approach employed was effective, in that it not only allowed the patients to accept their chronic pain condition, but also helped them to withdraw from the drug-dependent condition.<br>We conclude that a cognitive behavioral approach is important to help patients withdraw from a drug-dependence.

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