Addiction to Nefopam: A Case Report - Abstract
Introduction: Chronic non-cancer pain is a major public health issue. Analgesics are widely prescribed to provide relief to patients. Misusing these medications or their long-term use may be harmful.
Objective: To report one case of addiction to nefopam, a non opioid analgesic
Observation: A 50 year-old physician woman, with history of celiac disease in childhood, depression, anorexia nervosa, dependence to benzodiazepine, carbamate and buprenorphine, osteoporosis and scoliosis was prescribed nefopam by intramuscular route for relieving back pain twelve years ago. She developed dependence to nefopam and reported depressive symptoms
when attempting withdrawal. Nefopam consumption reached 600 mg per day. Numerous medications were attempted, with no improvement of patient’s state. Symptoms as manipulation, sex proposals with patients, requesting money to families of patients, a poor speech, blank stare, memory impairment and suicidal thoughts were noticed. During one period of nefopam abstinence, patient displayed geophagia. When withdrawal was obtained, she started tobacco
consumption and became dependent to tobacco.
Discussion: The patient meets DSM V criteria for nefopam substance use disorder. Few cases have been reported. Painful diseases are usually associated with nefopam substance use disorder. Amygdala’s system and nefopam psychostimulant effect may be involved in dependence behavior.
Conclusion: Prescription of analgesics in patients with chronic pain may require caution. Physicians, pharmacists and patients should be informed about risks related to nefopam. Non pharmacologic treatments and other non opioid medications should be promoted and integrated
in multimodal and multidisciplinary care management to provide a biopsychosocial intervention.