Use of high-dose oxycodone hydrochloride in patients with visceral and neuropathic pain

Case study

The patient, R. A., aged 39, male, was referred to the Department of Oncology at the University Hospital in Krakow in March 2013 due to caecal cancer with liver, peritoneal, and abdominal lymph nodes metastases.
The disease was diagnosed in February 2013 when the patient underwent a diagnostic procedure because of abdominal pain that had started approximately three months earlier and weight loss (approx. 10 kg in three months). Based on histopathological examination of samples taken during colonoscopy, an adenocarcinoma of the cecum was diagnosed. The imaging examinations revealed the presence of pathologically enlarged lymph nodes in the area of ileocaecal vessels and metastatic lesions in the liver (segment 4 and the boundary between segments 4 and 1). The patient was qualified for palliative surgery: a right-sided hemicolectomy was performed, with intraoperative biopsy of the hepatic lesions; the presence of metastases in the vesicorectal space was also confirmed. The postoperative histological examination revealed poorly differentiated adenocarcinoma (G3), the stage being determined as IVB (pT3N2bM1b). The patient was referred to the Department of Oncology at the University Hospital for further treatment. The patient did not report any pain, and his performance status was described as good (ECOG 0). Of note was chronic hepatitis B and well-controlled primary hypertension in his medical history. Due to the advanced stage of the disease, the patient was qualified for palliative chemotherapy according to the FOLFIRI regimen (5-fluorouracil, leucovorin, irinotecan).
A systemic treatment was started, which was well tolerated by the patient. The treatment was continued until the sixth series, with control imaging examinations performed after the last one. Computed tomography of the abdomen revealed hepatomegaly and progression of metastatic lesions in the liver, the peritoneum, and the lymph nodes around the celiac trunk and the ileocecal vessels. A decision was made to launch a second-line chemotherapy regimen, FOLFOX4 (5-fluorouracil, leucovorin, oxaliplatin) + bevacizumab. The patient tolerated the treatment well; however, in the course of treatment, they reported an incidence of dull, diffuse, poorly localised pain of a gripping and cramp-like nature. According to the self-assessment of the patient, the pain intensity on the NRS scale reached the level of 3/10. Meloxicam, a non-opioid analgesic of the NSAID group, was...


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