In the United States the most common
cancers of the head and neck are those of the oral cavity and pharynx. In 2007,
oral cancer will be diganosed in more than 37,000 Americans and will claim more than 7,500 lives. The report presented here describes a case of extrarodinary
pain in a woman with metastatic
adenocarcinoma of the hard palate. At the time of her referral for
hospice care, she was experiencing excruciating, unremitting,
chronic pain graded 10 of 10 on a standard
pain scale. Her
analgesic treatment consisted of
opioids prescribed in increasingly higher doses until they were ineffective, the effects of treatment could not be tolerated, or she could not swallow the quantity or oral medication needed to provide relief. Only the
opioid levorphanol has provided effective
analgesia with few adverse effects, and the patient's malignant
pain is manageable with far fewer doses of oral medication. Comments from the patient's physician, the
pain management specialist who provided the successful conversion between
analgesic therapies, the patient's husband, and the compounding pharmacist who used his own funds to pay in advance for treatment are provided. Formulations of compounded
levorphanol are also featured, and the patient described in this report kindly discusses the results of her treatment.