The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Implantable Intrathecal Drug Delivery Pump in Complex Regional Pain Syndrome Patient -A case report-

복합부위통증증후군 환자에게 시행한 매몰식 펌프를 이용한 지주막하강 내 약물투입 -증례보고-

  • Seo, Kyung Soo (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University) ;
  • Han, Kyung Ream (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University) ;
  • Kim, Sae Young (Pain Clinic, CHA General Hospital, College of Medicine, Pochon CHA University) ;
  • Park, Kyeong Eon (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University) ;
  • Kim, Chan (Department of Anesthesiology and Pain Medicine, Ajou University Hospital, College of Medicine, Ajou University)
  • 서경수 (아주대학교 의과대학 부속병원 마취통증의학교실) ;
  • 한경림 (아주대학교 의과대학 부속병원 마취통증의학교실) ;
  • 김세영 (포천중문의과대학교 분당차병원 통증클리닉) ;
  • 박경언 (아주대학교 의과대학 부속병원 마취통증의학교실) ;
  • 김찬 (아주대학교 의과대학 부속병원 마취통증의학교실)
  • Received : 2009.01.09
  • Accepted : 2009.01.22
  • Published : 2009.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

Keywords

References

  1. Galer BS, Schwarz L, Allen RJ: Complex regional pain syndromes-type I: Reflex sympathetic dystrophy, and type II: Causalgia. In: Bonica's management of pain. 3rd ed. Edited by John D, Loeser MD: Philadelphia, PA, Lippincott Williams & Wilkins. 2001, pp 388-411
  2. Baron R: Complex regional pain syndromes. In: Wall and Melzack's textbook of pain. 5th ed. Edited by MacMahon SB, Koltzenburg M: Philadelpia, PA, Elsevier Churchill Livingstone. 2006, pp 1011-27
  3. Pert CB, Snyder SH: Opiate receptor: demonstration in nervous tissue. Science 1973; 179: 1011-4 https://doi.org/10.1126/science.179.4077.1011
  4. Ruan X: Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician 2007; 10: 357-66
  5. Burton AW, Rajagopal A, Shah HN, Mendoza T, Cleeland C, Hassenbusch SJ 3rd, et al: Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med 2004; 5: 239-47 https://doi.org/10.1111/j.1526-4637.2004.04037.x
  6. Simpson RK Jr: Mechanisms of action of intrathecal medications. Neurosurg Clin N Am 2003; 14: 353-64 https://doi.org/10.1016/S1042-3680(03)00013-5
  7. Gilmer-Hill HS, Boggan JE, Smith KA, Wagner FC Jr:Intrathecal morphine delivered via subcutaneous pump for intractable cancer pain: a review of the literature. Surg Neurol 1999; 51: 12-5 https://doi.org/10.1016/S0090-3019(98)00080-9
  8. Koulousakis A, Kuchta J, Bayarassou A, Sturm V: Intrathecal opioids for intractable pain syndromes. Acta Neurochir Suppl 2007; 97: 43-8
  9. Krames ES: Intraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines. J Pain Symptom Manage 1996; 11: 333-52 https://doi.org/10.1016/0885-3924(96)00010-3
  10. Hassenbusch SJ: Epidural and subarachnoid administration of opioids for nonmalignant pain: technical issues, current approaches and novel treatments. J Pain Symptom Manage 1996; 11: 357-62 https://doi.org/10.1016/0885-3924(96)00009-7
  11. Sylvester RK, Lindsay SM, Schauer C: The conversion challenge: from intrathecal to oral morphine. Am J Hosp Palliat Care 2004; 21: 143-7 https://doi.org/10.1177/104990910402100214
  12. Jacobson L, Chabal C, Brody MC: A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. Anesth Analg 1988; 67: 1082-8 https://doi.org/10.1213/00000539-198867110-00011
  13. Belverud S, Mogilner A, Schulder M: Intrathecal pumps. Neurotherapeutics 2008; 5: 114-22 https://doi.org/10.1016/j.nurt.2007.10.070
  14. Hassenbusch SJ, Paice JA, Patt RB, Bedder MD, Bell GK:Clinical realities and economic considerations: economics of intrathecal therapy. J Pain Symptom Manage 1997; 14 (Suppl 3): 36-48 https://doi.org/10.1016/S0885-3924(97)00169-3
  15. Krames ES, Lanning RM: Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine. J Pain Symptom Manage 1993; 8: 539-48 https://doi.org/10.1016/0885-3924(93)90083-8
  16. Chaney MA: Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891-903 https://doi.org/10.1007/BF03011037
  17. Bejjani GK, Karim NO, Tzortzidis F: Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature. Surg Neurol 1997; 48: 288-91 https://doi.org/10.1016/S0090-3019(96)00466-1
  18. Kumar K, Kelly M, Pirlot T: Continuous intrathecal morphine treatment for chronic pain of nonmalignant etiology:long-term benefits and efficacy. Surg Neurol 2001; 55:79-86 https://doi.org/10.1016/S0090-3019(01)00353-6

Cited by

  1. Repetitive single subarachnoid injections for trial administration of the intrathecal morphine pump in patients with intractable non-cancer pain -A case report- vol.60, pp.2, 2011, https://doi.org/10.4097/kjae.2011.60.2.138
  2. The Intrathecal Drug Administration System vol.22, pp.2, 2009, https://doi.org/10.3344/kjp.2009.22.2.117