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Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature

Published online by Cambridge University Press:  25 October 2007

Hideki Onishi ,
Wataru Yamamoto ,
Makoto Wada ,
Tomomi Nishida ,
Mei Wada ,
Yu Sunagawa ,
Toshimichi Miya ,
Chiaki Kawanishi ,
Masaru Narabayashi  and
Yasutsuna Sasaki
Hideki Onishi*
Affiliation:
Department of Psycho-Oncology, Saitama Medical University, Saitama, Japan
Wataru Yamamoto
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Makoto Wada
Affiliation:
Department of Psychiatry, Kyoto University School of Medicine, Kyoto, Japan
Tomomi Nishida
Affiliation:
Department of Psychiatry, Sakamoto Hospital, Sakamoto, Japan
Mei Wada
Affiliation:
Department of Clinical Psychology, Kitasato Medical University, Kitasato, Japan
Yu Sunagawa
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Toshimichi Miya
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Chiaki Kawanishi
Affiliation:
Department of Psychiatry, Yokohama City University, Yokohama, Japan
Masaru Narabayashi
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Yasutsuna Sasaki
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
*
Corresponding author: Hideki Onishi, Department of Psycho-Oncology, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan. E-mail: honishi@saitama-med.ac.jp
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Abstract

Objective:

There is substantial evidence that tricyclic antidepressants are effective in the management of chronic pain, including cancer pain. In oncological settings, these agents are used as adjuvant analgesic drugs. However, cases of akathisia due to tricyclic antidepressants used as adjuvant analgesic therapy have not previously been reported.

Case reports:

Two cancer patients experiencing chronic pain who were refractory to nonsteroidal anti-inflammatory drugs and opioids were prescribed amoxapine as an adjuvant analgesic therapy for neuropathic pain. These patients developed inner restlessness and restless physical movements after amoxapine was prescribed. Although symptoms were atypical, akathisia was suspected and discontinuation of amoxapine resolved the symptoms.

Results and significance of results:

Akathisia should be considered in patients receiving adjuvant analgesic therapy with tricyclic antidepressants. Early detection and appropriate treatment will relieve this distressing symptom. Restless movements involving parts of the body other than the legs may be the clue to the diagnosis.

Keywords

CancerPain controlAkathisiaTricyclic antidepressants
Type
Case Report
Information
Palliative & Supportive Care , Volume 5 , Issue 4 , December 2007 , pp. 411 - 414
Copyright
Copyright © Cambridge University Press 2007

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