The Use of Methadone in Refractory Headache Pain in an Opiate Naive Patientwith Non Metastatic BurkittâÂÂs Lymphoma and HIV - A Case Report

Abstract

In extreme cases Methadone has been used for severe pain in oncologic patients; frequently cancer patients have severe headaches in addition to their pain. This patient is a 50 year old Hispanic female with metastatic Burkitt’s Lymphoma and controlled HIV on triple therapy. Throughout her inpatient hospitalizations of chemotherapy with R-EPOCH and then salvage chemotherapy in addition to pancytopenia she experienced consistent pain of 9-10 out of 10 on the pain scale and headaches of 9-10 in severity out of 10. The patient underwent various methods of pain and headache control including PCA of hydromorphone, intravenous and oral hydromorphone, intravenous morphine, intravenous Tylenol, Fioricet and oral analgesics. The patient received moderate relief with oral Methadone of both her pain and headaches, bringing the pain and headache scale down to a 4-5 out of 10. This is the first case of intractable pain and headaches in an opiate naive patient with non-metastatic Burkitt’s Lymphoma and HIV that received with 50 percent reduction in symptoms from the addition of oral Methadone that has no prior use of opiate abuse or dependence.