Methylphenidate for the management of somatization in terminal cancer patients

We report a case that illustrates methylphenidate's (MP) usefulness in the management of psychological distress and associated somatization in the palliative-care setting. A 60-year-old man affected by terminal cancer of the prostate had been complaining of increasing physical pain, without any evidence of significant disease progression, opioid toxicity, or previous history of drug addiction. Because of patient's denial, the team had been unsuccessful in identifying any potential emotional factors affecting his physical suffering. MP could both counteract opioid-induced sedation and improve pain control through a positive action on patient's mood. In spite of a rapid development of tolerance, which required a subsequent escalation in MP daily doses, the drug was well tolerated and the patient could die in good physical comfort 2 weeks later.