The Use of an Intrathecal Pump to Manage Intractable Cancer Pain in a Pediatric Patient

Abstract

A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was limited by significant side effects of mental status changes and urinary retention leading to clinical deterioration that precluded attempts at chemotherapy. An intrathecal pump was implanted in the challenging setting of neutropenia. There was a drastic improvement in her quality of life and the ability to tolerate further chemotherapy. The option of an intrathecal pump for pain control extended our patient's ability to enjoy important quality time with family by several months.

Intrathecal Pain Pump for Pediatric Perverse Oncological Pain

“…As in the presented case, the teen developed a complication of urinary retention while taking oral opioids. It is important to recognize that opioid solutions within the IT pump system are also associated with transient urinary retention immediately after placement (Bengali et al, 2014). In the case study, the teen's urinary retention dissipated after switching to the IT analgesic route.…”

“…Inadequate pain management with conservative medical treatment and intolerable side effects, as illustrated in the previous case, is the chief motivation for considering the analgesic IT device (Bengali et al, 2014). Compared to oral administration, the IT route bypasses gut absorption, carriers, and the blood-brain barrier for speedier effect with reduced doses of opiates and enhanced analgesia with fewer side effects.…”

“…However, it is important to note that none of the teens required hospitalization secondary to pain crisis during the follow-up period. Bengali et al (2014) presented a case report of a fifteen-year-old adolescent with combined immune deficiency syndrome and diagnosed with metastatic squamous cell cancer of the anus. This teen had significant pain secondary to vulvar-perianal condyloma.…”

“…Uncontrolled cancer pain poses a discouraging and depressing obstacle for teens and their families in a hospice or palliative care environment. The majority of cancer pain is thought to be more neuropathic and often does not respond well to enteral opioids (Bengali, Huang, & Gular, 2014). Chronic pain in children can impact their social and psychological development.…”

Treatment of Anal Cancer Pain—A Case Report

“…Bengali and colleagues used an intrathecal pump for pain control in a 15-year-old girl with immune deficiency syndrome, metastatic squamous cell cancer, and pain secondary to vulvarperianal condyloma. 6 Calcium channel blockers have also been used to treat chronic malignancyeassociated perineal pressure like pain and tenesmus. 7 Symptoms associated with lumbosacral plexopathy, an unrecognized consequence of treatment of anal cancer treatment with chemotherapy and radiation, are usually treated with opioids, steroid suppositories, and lidocaine ointments.…”