Intravenous naloxone plus transdermal buprenorphine in cancer pain associated with intractable cholestatic pruritus

The complex and unpredictable series of symptoms that comes with the terminal stage of neoplastic disease significantly compromises patients’ quality of life, and poses harsh therapeutic challenges for clinicians. Good control of severe cancer-related cholestatic pruritus seems to be hard to achieve and pruritus still undermines the remaining physical and relational capabilities of seriously ill cancer patients. Its pathogenesis remains substantially unknown and its treatment mostly empirical. An increased central opioidergic tone seems to be an important component of cholestatic pruritus, with hyperactivity of the serotoninergic system playing a primary role. These elements were the basis for the therapeutic choice successfully applied in the following clinical case.