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Hyper-Acute Toxic Delirium In A Patient Using Transdermal Fentanyl

Delicou Sophia, Kourouni Ismini, Samarkos Michael, Kouzis Panagiotis , Mantzourani Marina

The unpredictable, recurrent, intense, and frequently persistent nature of pain associated with sickle cell disease poses a difficult challenge in terms of management. The long-term treatment of non-malignant pain with opioids has traditionally been a matter of debate globally due to the perceived fears of addiction, toxicity and tolerance [1]. In the past decade, opioid analgesics have been advocated by some medical professionals for the treatment of refractory non-malignant pain. For patients with SCD and chronic pain, the pain differs from other forms of chronic pain (e.g., cancer pain) in that sickle cell pain is typically associated with episodic and chaotic waxing and waning acute pain on top of chronic pain. There is also likely to be a larger component of neuropathic pain, peripheral and central sensitization to pain, and opioid hyperalgesia in patients with SCD. In addition, unlike individuals with cancer who have pain, patients with SCD live with this pain for decades? Transdermal fentanyl (Duragesic) is indicated for patients who require continuous opioid administration for the treatment of chronic pain that cannot be managed with other medications such as short-acting opioids on an as-needed basis or non-opioid analgesics. Pain should be under relatively stable control prior to the initiation of transdermal fentanyl, since meaningful pain relief is not obtained until 12-16 hours after application.We describe here the case of a fifty-year-old woman with sickle cell/beta thalassemia complicated by multiple painfull crisis admissions and suspected opioid abuse, who manifested unusual psycho-mimetic reactions after the first-time application of transdermal fentanyl.