Intrathecal Analgesic Drug Delivery is Effective for Analgesia in a Patient with Post-Poliomyelitis Syndrome: A Case Report

Abstract

Patient: Female, 45Final Diagnosis: Post-poliomyelitis syndromeSymptoms: Chronic painMedication: Fentanyl • Oxycodone • Gabapentin • Naproxen • ParacetamolClinical Procedure: Intrathecal analgesic drug deliverySpecialty: AnesthesiologyObjective:Unusual setting of medical careBackground:Post-poliomyelitis syndrome (PPS) is a progressive neuromuscular syndrome, with chronic pain being one of the most prevalent symptoms. We present a case report on intrathecal analgesic drug delivery to diminish chronic, refractory pain in a patient with PPS.Case Report:In a wheelchair-bound 45-year-old female patient (Caucasian, body mass index [BMI] 20.5) with severe chronic, refractory pain, a Synchromed® II pump (Medtronic, Minneapolis, Minnesota, USA) was implanted after multi-disciplinary consultation and a successful trial period. After 8 months, relocation of the pump due to regional pressure problems with surrounding erythema had to occur. A second pump relocation due to pressure problems and skin erosion was needed 18 months after the first relocation, moving from the abdominal wall to the sheath of the rectus abdominis muscle, resulting in resolution of the problems.Conclusions:In patients with PPS, intrathecal analgesic drug delivery can be an option to treat chronic, refractory pain. Multidisciplinary consultation is necessary to deal with the wide variety of problems in these patients. Skin problems at the site of the pump reservoir can be challenging and time-consuming and, ultimately, can necessitate relocation (or removal) of the device.

Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient

“…Clinical investigation may include imaging, such as X-ray, CT scan, radionuclide scans, and catheter dye studies (208,212). Skin erosion over the implant site often necessitates device removal, with special precautions for withdrawal, depending on intrathecal agents (213).…”