Dados do Trabalho

Título

Cannabidiol: New perspectives for treatment of Post-mastectomy pain syndrome, a Case-Report.

RESUMO

Case presentation: J.C.A female, 46 years old, presents to the neurology outpatient clinic with a complaint of disabling pain in the hemithorax and right upper limbs after mastectomy and worsening with subsequent ipsilateral radiotherapy in 2018. The patient reports that the pain interferes with the quality of her sleep and limits her daily activities. It is characterized as arrowheads, without irradiation, constant, but with frequent exacerbations, 10 out of 10 on the pain scale, accompanied by paresthesia and loss of strength in the affected limb. A directed physical examination was not performed because the patient was intolerant to touch and movement. She takes several medications, including vitamin B and D, clonazepam, dipyrone, pregabalin, amitriptyline, and methadone, without improvement. She has a history of intestinal, rectal, and breast cancer, the latter still active. She was diagnosed with post-mastectomy pain syndrome (PMPS), maintained on previously prescribed medications, and introduced cannabidiol 250mg per serving. After 7 days using 3 drops a day, the patient reported improvement, with pain 8 out of 10. In the following 7 days he started taking 7 drops a day with the same concentration, with significant improvement, reporting pain 5 out of 10, which allowed the reduction of the methadone dose. Discussion: PMPS is a chronic neuropathic pain, resulting from direct injury or scar tissue formation of plexuses and nerves ipsilateral to the mastectomy, and may be aggravated by local radiation-based therapies such as radiotherapy. Nerve injury results in inflammatory processes that favor ectopic impulses and neuronal hyperexcitability, and thus neuropathic pain. Thus, due to its anti-inflammatory potential and ability to modulate pain pathways and dopamine release, which interferes with the response to pain, it is possible to understand the choice of cannabidiol as a therapeutic measure for the condition, considered refractory to conventional therapy, as well as the response presented by the patient after years without any improvement. Final comments: In this perspective, despite the findings that speak in favor of the therapeutic potential of cannabidiol, it is important to emphasize the need for more studies to deepen the knowledge on the subject in question.

Palavras Chave

Cannabidiol; Post-mastectomy pain syndrome; Pain