tremor and oxycodone
A woman, age 77, came to me for treatment of chronic pain in the right wrist. This dated from a fracture and unsuccessful surgery nine years before. On exam, her wrist was stiffened and painful to the touch but the most striking finding was an unusual tremor involving the hand, wrist, and forearm. It was not a back and forth tremor. Rather, it was a writhing, twisting, snake like movement, described technically as a choreoathetotic tremor. I have occassionally seen tremors in painful extremities but never of this type.
She had seen several doctors and been given drugs for the tremor and the pain but none had helped except the low grade opiate, Darvocet. It's benefit was modest, however, and I sensed her doctors were reluctant to use a stronger pain killers possibly because of her age and the risk of addiction.
I might have felt that way a few years ago but not now. Really, the only thing I could offer the lady was opiate therapy. She was fearful but I tried to explain that the drug might relieve her pain and that although there might be some side effects,the risk of addiction was extremely low. The woman had lived 77 years without becoming addicted to anything. Scant chance that addiction would appear at her age.
I prescribed oxycodone in a test dose, 5-10 mg. three times daily and the results were miraculous. Her pain was much controlled and her coarse, writhing tremor was arrested, totally. Nine years of distressing, disfiguring tremor vanished almost overnight with opiate therapy. Had the much feared opiate drugs been given sooner, I'm sure the lady's life would have been much more comfortable.
The outcome, at least regarding the tremor, was probably dumb luck. I certainly didn't expect the oxycodone to relieve the tremor. To relieve the pain, sure, but the tremor? I never expected that.
I certainly don't endorse opiates for the treatment of tremors but that may be changing. They are increasingly recognized as useful in preventing the painful tremor known as restless legs
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