Fosaprepitant for the Management of Refractory Pain in a Patient with Cancer-Related Dermatomyositis.

OBJECTIVE: Optimal pain management often requires multiple pharmacological interventions with the goal of disrupting the pain-signaling pathway and targeting the underlying pathophysiology. Off label use of nonpain medications may have a role in treating refractory pain syndromes.

BACKGROUND: We report a case of a 60-year-old female with refractory nociceptive and neuropathic pain. Conventional therapies were either ineffective or fraught with side effects. Given the underlying inflammatory nature of her pain syndrome, and the role of substance P (SP) in pain transmission and modulation, we decided to use fosaprepitant, an SP and neurokinin-1 (NK1) receptor antagonist. The patient tolerated fosaprepitant and experienced acceptable analgesia without compromising her mental functioning.

DESIGN: Study and analysis of a case of a patient with refractory mixed, nociceptive, and neuropathic pain syndrome treated with fosaprepitant.

RESULTS AND DISCUSSION: Fosaprepitant is a potentially novel adjuvant therapy for the treatment of refractory inflammatory pain syndromes in palliative care.