Chronic pain, depression and opioids misuse in elderly people. A case report.

Abstract

Background:

Chronic pain is associated with opioid prescription. Chronic pain, as well as mental disorders are associated with initiation and use of prescribed opioid in the general population. Furthermore, psychiatric disorders are associated with increased physical symptoms and may be associated with opioid use (Sullivan et al., 2005).

Aims:

To report a case in order to underline the relationship between chronic pain, depression and opioids misuse.

Methods:

Case study and description of a patient admitted in a General Hospital.

A literature's review about chronic pain, depression and opioids misuse in elderly people was made through PubMed.

Results:

A 73 year old woman was admitted in a General Hospital's emergency room for renal failure related to opioid abuse. The patient was prescribed opioid 10 years ago, to treat spinal cord pain, which she followed until 2 years ago. At that time, she began to misuse her treatment. The case review showed that the patient had been suffering from an under diagnosed depression. The depression may have diminished her pain tolerance threshold, inducing opioid misuse.

Conclusions:

In patients with chronic pain, there is a need to deal with patient's psychopathology when considering opioid treatment.

Pain tolerance threshold may diminish when patient suffers from a mental disorder.

When opioid medication is less effective, psychiatric comorbidities should be evaluated, instead of increasing opioid medication.

As many elderly patients suffer from chronic pain, it's recommended that they are evaluated for opioid misuse, especially when presenting with an unexpected clinical profile.