PAIN UPDATE
from The Richeimer Pain Institute
March 2000

REFRACTORY HICCUPS

Do you ever have patients with refractory hiccups?  Here is one of my semi-secret palliative care pearls:

The treatment that I have used with fair success is oral baclofen (Lioresal).    I  have found oral baclofen doses of 5 to 10 mg, three times a day, to be effective in reducing or eliminating the hiccups. 

A recent letter to the editor of the Journal of Pain and Symptoms Management confirms success with this treatment.  Several case reports are noted, often associated with cancer, of patients with hiccups that had been only marginally responsive to more traditional treatments with metoclopramide (Reglan) or chlorpromazine (Thorazine).

Oral baclofen is generally well tolerated.  Occasionally, I have had an elderly patient develop mild symptoms of delirium, necessitating its discontinuation.  Also on occasion, patients need to take baclofen with food in order to prevent nausea.  If you ever end up using high dose baclofen, remember that it should be tapered off, rather than discontinued abruptly.

I have had patients with significant pain complain to me even more about their hiccups than about their pain.  It is wonderful when we can find simple solutions.

Until next time,

Steven Richeimer, M.D.

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Steven Richeimer, MD
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