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Intractable Central Pain in a Patient With Diffuse Glioma

Horan, Nicholas Aaron MD; Pugh, Terrence MacArthur MD

American Journal of Physical Medicine & Rehabilitation: September 2019 - Volume 98 - Issue 9 - p e107–e110
doi: 10.1097/PHM.0000000000001094
Case Report
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Central neuropathic pain can be difficult to treat and, subsequently, cause a great amount of disability and distress to patients, which limits quality of life. Common etiologies include the following: stroke, spinal cord injury, multiple sclerosis, infection, vasculitis, and malignancy. This case is a description of an 18-yr-old male patient diagnosed with a grade IV diffuse glioma who experienced severe neuropathic pain refractory to first-line treatment options including the following: gabapentinoids, tricyclic antidepressants, and selective serotonin and norepinephrine reuptake inhibitors. The patient remained on high-dose oral gabapentin as well as methadone and high-dose oxycodone for pain control at the time of submission. The aims of this case report were to review the nociceptive pathways and to explore the role of opioids in central neuropathic pain secondary to neoplasm because a better understanding of these topics can aid physiatrists in better taking care of these patients and improving function and quality of life.

From the Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina.

All correspondence should be addressed to: Nicholas Aaron Horan, MD, 1100 Blythe Blvd, Charlotte, NC 28203.

Nicholas Aaron Horan is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

Online date: November 20, 2018

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