【案例報告】非癌慢性疼痛病人以精神科藥物配合精神科社區復健活動介入之改善案例 To Improve Pain Control in Non-Malignancy Patients with Psychiatric Medications and Community Psychiatric Rehabilitation
Chronic pain is defined as persistent painful feeling for more than three months. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually effective when applied against non-malignant chronic pain. The opioid is considered to use if no distinct progress is observed. This study case is to be evaluated how community psychiatric rehabilitation involvement provided improvement to a non-malignant chronic pain patient after failure in long-term psychotics and opioids usage. A 49-year-old female had developed insomnia and lower-back pain since 1999. In 2007, despite the patient starting to take antidepressants after been diagnosed as depressive, no pain relief was seen after long-term medication. Opiate (morphine 30 mg/day orally) was then introduced in July 2009; however, there was no reduction in opioid dosage while antidepressants were still being taken simultaneously. Hence, the patient was advised to participate in a community psychiatric rehabilitation program in August 2011. A significant reduction in opioid dosage was observed, which led to discontinuation of opioids in November 2011. Ongoing monitoring on pain and depression was followed up. Long-term opioid use appears essential for chronic pain patients from previous case studies. The possibility of depression should be considered if effectiveness is limited after long-term opioid use. Furthermore, this study indicates if patients participate in community psychiatric rehabilitation programs, pain level can be reduced effectively; hence, it is necessary to evaluate both psychiatric medications and community psychiatric rehabilitation prior to any long-term opioid use for nonmalignant chronic pain patients.