Open Access(213) Pain Reduction in Cognitively Impaired Cancer Patients Treated with Olanzapine
Author(s) -
Khojainova Natalia,
SantiagoPalma Juan,
Gonzales Gilbert R.
Publication year - 2001
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2001.pme01039-13.x
Subject(s) - olanzapine , medicine , anesthesia , reduction (mathematics) , cancer pain , cancer , schizophrenia (object oriented programming) , psychiatry , geometry , mathematics
Background: Anxiety and cognitive impairment may accompany and aggravate pain. Delirium is extremely common in patients with advanced cancer (up to 85%) and is frequently underdiagnosed. Neuroleptics for the treatment of delirium are standard clinical practice. Their use for pain management remains controversial due to the conflicting reports of their efficacy and their prominent side effects. Olanzapine, an atypical neuroleptic, might offer advantages over traditional neuroleptics because of its safer side effect profile. Also, independent antinociceptive activity of olanzapine was demonstrated in animals and is thought to be mediated by alpha‐2 adrenoreceptors, as well as some activity at dopamine and serotonin receptors. Reduction of pain in cognitively impaired cancer pain patients treated with olanzapine has not been previously described. Methods: We present 3 cancer patients with uncontrolled pain who received 2.5 to 5 mg of olanzapine daily to treat mild cognitive impairment and anxiety. Levels of pain, sedation and opioid use were measured 2 days before and 2 days after olanzapine was started. Cognitive function was monitored daily by a psychiatrist using DSM‐IV criteria. Results: 2 out of 3 patients were treated with intravenous hydromorphone and 1 intravenous with fentanyl. Cognitive impairment and anxiety resolved within 48 hours in all patients. All 3 patients had marked reduction of the average daily pain scores (from 7 to 1) and an average daily opioid use (64%) without increase in sedation. Discussion: Decreased pain scores and opioid requirements may have resulted from improvement in cognitive function and the known anxiolytic effects of olanzapine or direct or adjuvant analgesic effects of olanzapine. We conclude that olanzapine may be useful as an adjuvant in the treatment of patients with reversible cognitive impairment or severe anxiety and uncontrolled cancer pain. Studies are needed to further evaluate olanzapine's possible independent or opioid synergistic analgesic effect.