LAS VEGAS – Lofexidine may effectively mitigate the symptoms of opioid withdrawal in patients on long-term opioid therapy for chronic pain, according to a case study presented at PAINWeek 2019 held September 3-7 in Las Vegas, Nevada.

The case of a woman aged 54 years with chronic pain secondary to lumbar spondylosis and radiculopathy who also had cervical spondylosis, fibromyalgia, chronic migraine headache, type 2 diabetes, and posttraumatic stress disorder was presented. The patient reported chronic pain onset in the 1980s following a motor vehicle accident, which resulted in a whiplash-type neck pain. Other pain conditions developed later.

The patient had been treated with biofeedback, transcutaneous electrical nerve stimulation, acupuncture, and interventional pain treatments including myofascial trigger point injections and radiofrequency neurotomy. She had received several pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, muscle relaxants, antispasmodics, tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, antiepileptic medications, and opioids.

The patient was seen by the author after a multiyear history of chronic opioid therapy, primarily for management of intractable back pain. She had been using fentanyl transdermal patch 100 μg/h and reported inadequate pain relief (<30% reduction in pain).

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The patient agreed to a gradual opioid dose-reduction plan, with a reduction of the fentanyl patch dose 12 μg/h per dose every 2 weeks. She continued taking gabapentin and duloxetine and was started on diclofenac.

Because of significant withdrawal symptoms, including nausea, vomiting, insomnia, and increased pain, the patient did not tolerate dose reductions of more than 25 μg/h.

To further taper her opioid dose, she was started on lofexidine while reducing the fentanyl patch dose to 12 μg/h. After 2 weeks, she discontinued the patch but was maintained on lofexidine for another 3 days. The patient reported minimal withdrawal symptoms while taking lofexidine and was able to return to work.

Disclosure: This clinical trial was supported by US WorldMeds, LLC, Louisville, KY, USA. Please see the original reference for a full list of authors’ disclosures.

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Reference

Adler J. Lofexidine for the management of opioid withdrawal syndrome in a patient discontinuing opioid therapy for chronic pain. Presented at: PAINWeek 2019; September 3-7, 2019; Las Vegas, NV. Poster 49.