THE COMBINATION OF PAIN AND AGGRESSION - TWO IMPRESSIVE AND REPRESENTATIVE CASE REPORTS

Background: It is widely accepted that manifestations of pain cannot be detached from the case history, accompanying diseases, and the individual medication profile. An indirect association between pain and aggression (due to psychosis) as a cause of administration of neuroleptics has not been described yet. Aim & method: Here we report the connection between treatment of pain and additional medication with a neuroleptic for patients with manifest aggression and psychotic background in two impressive cases. Course & outcome: Case 1: A 57-year-old male patient underwent surgery for an esophageal carcinoma. Since the second postoperative day, the patient had been given long acting morphine orally. After several days, the patient became verbally aggressive. As he was suffering from a depression, he was administered higher doses of neuroleptics. As a consequence, his pain and aggression were reduced significantly and permanently. Case 2: A 24-year-old male patient was surgically treated for colon carcinoma. He complained about abdominal pain. Under long acting tilidine 50mg, pain increased. Increasing dosage had no effect. However, intensity of pain (NRS 10) could only be reduced to NRS 2 by piritramide (7.5mg). Despite of the lack of psychotic disorders in the past the patient became verbally aggressive. Presuming a reactive psychosis, an administered neuroleptic reduced pain and aggression effectively and permanently. Conclusion: If administration of painkillers does not lead to an adequate reduction of pain in the patient, and if an accompanying psychosis is present or suspected, this can manifest as aggression, an additional administration of neuroleptics needs to be considered.