Abstract
This case report describes a possible unknown complication of morphine withdrawal in a patient with persistent back pain, treated with intrathecal morphine pump infusion. The patient presented with left lower extremity edema. After excluding deep vein thrombosis by Doppler ultrasound and worsening of the swelling despite oral antibiotics, peripheral edema caused by intrathecal morphine was suspected. Twelve hours following the termination of his intrathecal morphine pump and initiation of inequivalent doses of oral morphine and tramadol, he developed convulsions. After metabolic and structural causes of convulsion were ruled out by blood tests and head imaging, equivalent doses of morphine were given. Then the patient regained full consciousness, and no additional seizures occurred. After that, opioid withdrawal emerged as the most likely explanation. Seizure is a life-threating condition; therefore, an awareness of this case is important and further studies are warranted to explore the potential association of opioid withdrawal and seizure.
Highlights
Morphine withdrawal is a common medical problem
Patients with morphine withdrawal can present with a variety of symptoms including runny nose, watery eyes, fever, vomiting, nausea, headaches, sweating, chills, muscle aches, diarrhea, high blood pressure, agitation, anxiety, irritability, depression, disorientation, insomnia[1]
While a high degree of cerebral activity and seizure has been reported in rodent model opioid withdrawal studies[7], the link between opioid withdrawal and seizures is not well studied in adult humans
Summary
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