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Intractable Central Pain in a Patient with Diffuse Glioma

Case Report

Horan, Nicholas Aaron, MD1; Pugh, Terrence MacArthur, MD2

American Journal of Physical Medicine & Rehabilitation: November 19, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001094
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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: stroke, spinal cord injury, multiple sclerosis, infection, vasculitis, and malignancy. This case is a description of an 18-year-old male patient diagnosed with a grade IV diffuse glioma who experienced severe neuropathic pain refractory to first-line treatment options including: 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 purpose of this case report is to review the nociceptive pathways as well as explore the role of opioids in central neuropathic pain secondary to neoplasm as a better understanding of these topics can aid in physiatrists better taking care of these patients and improving function and quality of life.

1Resident Physician, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina; nicholas.horan@carolinashealthcare.org

2Faculty Physician, Assistant Professor, Associate Director of Oncology Rehabilitation, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina; Terrance.Pugh@carolinashealthcare.org

Corresponding Author Details: 1Nicholas Aaron Horan, 1100 Blythe Blvd, Charlotte, NC 28203, Ph: 704-355-6050, Fax: 704-355-0709. nicholas.horan@atriumhealth.org

Author Disclosures:

No competing interests or sources of funding were provided for this case report. No financial benefits were present for the authors. This case has not been presented or published in any form.

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