Levorphanol for excruciating pain from oral cancer: a case report

In the United States the most common cancers of the head and neck are those of the oral cavity and pharynx. In 2007, oral cancer will be diganosed in more than 37,000 Americans and will claim more than 7,500 lives. The report presented here describes a case of extrarodinary pain in a woman with metastatic adenocarcinoma of the hard palate. At the time of her referral for hospice care, she was experiencing excruciating, unremitting, chronic pain graded 10 of 10 on a standard pain scale. Her analgesic treatment consisted of opioids prescribed in increasingly higher doses until they were ineffective, the effects of treatment could not be tolerated, or she could not swallow the quantity or oral medication needed to provide relief. Only the opioid levorphanol has provided effective analgesia with few adverse effects, and the patient's malignant pain is manageable with far fewer doses of oral medication. Comments from the patient's physician, the pain management specialist who provided the successful conversion between analgesic therapies, the patient's husband, and the compounding pharmacist who used his own funds to pay in advance for treatment are provided. Formulations of compounded levorphanol are also featured, and the patient described in this report kindly discusses the results of her treatment.