Interventional Pain Management for the Pediatric Cancer Patient: A Literature Review.

This literature review examines the use of interventional treatments for pain management in pediatric cancer patients. While interventional procedures may be effective in cancer pain management, these procedures are infrequently employed in pediatric cohorts. This underutilization of interventional procedures may be supported by a deficit in randomized, controlled studies and literature regarding their role in pediatric cancer populations. Particularly because literature on the efficacy of interventional treatments in adult populations may not directly translate to pediatric populations, more research about the role of interventional procedures in managing pediatric cancer pain is necessary for a strengthened understanding of pediatric cancer pain treatment.

Associated mood changes with naloxegol therapy for opioid-induced constipation in a patient with psychiatric disease.

The objective of this clinical case report is to highlight unusual adverse effects brought on by naloxegol therapy in a patient with underlying psychiatric illness. The patient is a 68-year-old female, with a psychiatric history of bipolar disorder, who presented for chronic pain management and opioid-induced constipation. After failing other therapies, she was trialed on naloxegol on three separate occasions. She experienced mood lability with symptoms including agitation, confusion, irritability, hysteria and unprompted crying spells on each occasion. Notably, the drug manufacturer does not describe mood lability, nor the profound psychiatric manifestations outlined in our case report, as side effects of Naloxegol. Clinicians may consider judicious prescription of naloxegol when treating opioid-induced constipation in patients with pre-existing psychiatric co-morbidities.

Lay abstract Our case report describes a patient with a history of pre-existing psychiatric illness and chronic pain treated with opioids who experienced unusual psychiatric side effects with naloxegol treatment. Naloxegol is used in patients who suffer from constipation from treatment with long-term opioids, often after not responding to the first-line treatment, which is stool-softeners and laxatives. Our patient, a 68-year-old female with bipolar disorder, tried naloxegol multiple times and each time experienced side effects that resolved after stopping the medication. Her symptoms included agitation, confusion, irritability, hysteria and unprompted crying spells. The drug manufacturer states that the most common side effects are gastrointestinal, such as diarrhea and nausea, but does not mention these types of psychiatric symptoms as possible side effects.