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Text
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<a href="http://doi.org/10.1016/0304-3959(95)00094-9" target="_blank" rel="noreferrer">http://doi.org/10.1016/0304-3959(95)00094-9</a>
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Title
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Massive opioid resistance in an infant with a localized metastasis to the midbrain periaqueductal gray
Publisher
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Pain
Date
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1995
Subject
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infant; Male; Analgesics; Non-U.S. Gov't; Newborn; Dose-Response Relationship; Drug; Human; Case Report; Palliative Care; Mesencephalon; Periaqueductal Gray; Brain Neoplasms/congenital/drug therapy/pathology/secondary; Drug Resistance; Hypnotics and Sedatives/therapeutic use; Morphine/therapeutic use; Opioid/therapeutic use; Rhabdoid Tumor/congenital/drug therapy/pathology/secondary; Support
Creator
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Collins J J; Berde CB; Grier HE; Nachmanoff DB; Kinney HC
Description
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We report the case of a 4-month-old infant with terminal malignancy who had systemic metastases and a localized metastasis to the dorsal midbrain periaqueductal gray (PAG). Extraordinary doses of opioids (dose equivalent of 2680 mg morphine sulfate/h, i.v.) were required to achieve adequate analgesia. The behavior of the infant, interpreted as being representative of a response to pain, may have been an aversive reaction due to the location of the lesion in the dorsal PAG. We propose that the lesion in the PAG impaired the responsiveness of this infant to the effect of opioids. This report is to alert clinicians to the possible role of the PAG in impaired opioid responsiveness in patients with terminal malignancy, as well as the possibility that pain-like signs (e.g., tachycardia, tachypnea, vocalization, facial grimacing) may indicate an aversive reaction rather than pain in non-verbal patients.
1995
Identifier
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<a href="http://doi.org/10.1016/0304-3959(95)00094-9" target="_blank" rel="noreferrer">10.1016/0304-3959(95)00094-9</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
1995
Analgesics
Backlog
Berde CB
Brain Neoplasms/congenital/drug therapy/pathology/secondary
Case Report
Collins J J
Dose-Response Relationship
Drug
Drug Resistance
Grier HE
Human
Hypnotics and Sedatives/therapeutic use
Infant
Journal Article
Kinney HC
Male
Mesencephalon
Morphine/therapeutic Use
Nachmanoff DB
Newborn
Non-U.S. Gov't
Opioid/therapeutic use
Pain
Palliative Care
Periaqueductal Gray
Rhabdoid Tumor/congenital/drug therapy/pathology/secondary
Support