P016: INTRATHECAL PUMP TREATMENT OF COMPLEX REGIONAL PAIN SYNDROME AFTER FAILED INTERVENTIONAL MODALITIES
Oleg Desyatnikov, DO1; Brandon Valls, OMS2; Leon Anijar, MD3; 1Department of Anesthesiology, Kendall Regional Medical Center; 2Lake Erie College of Osteopathic Medicine, Bradenton; 3Spine and Wellness Centers of America, Miami Beach
Introduction: Intrathecal drug delivery systems have been utilized for decades. Although techniques may vary among providers, intrathecal pump placement is commonly used for cancer and chronic pain patients. At this time its utilization still lags behind other pain control modalities. Intrathecal infusion pumps may offer an excellent alternative for patients receiving poor analgesia with alternative interventional or pharmacological techniques, as well as reduce overall opioid requirements and reduce side effects. We provide a case in which a patient diagnosed with chronic cervical pain in the form of complex regional pain syndrome in unilateral extremity who previously received minimal relief with alternative modalities found significant pain reduction after both intrathecal pump trial and permanent pump placement.
Case Report: A 40-year-old female with history of a work-related injury three years prior presents to an outpatient pain practice for consultation status post left-sided stellate ganglion block performed two weeks prior with no reported relief. The patient admits to persistent cervical spinal pain radiating down the left upper extremity, currently 10/10 in severity. The patient history includes cervical spinal cord stimulator placement. The patient currently takes Gabapentin, Celebrex, and Flexeril medication. Due to the lack of relief from the stellate ganglion block the patient is offered an intrathecal trial with 100mcg of Fentanyl. On two week follow up the patient had greater than fifty percent reduction in overall pain and was scheduled for permanent intrathecal pump placement. At the follow up visit after permanent placement the patient reported significant reduction in overall pain symptoms.
Discussion: We present a case of a patient with complex regional pain syndrome of the left upper extremity after a work place injury several years ago. Treatment with intrathecal pump placement provided significant analgesia after failed alternative modalities including spinal cord stimulator placement as well as stellate ganglion block. Some studies show that intrathecal drug delivery systems do not decreased oral opioid use, but our case shows that after other failed modalities intrathecal pump provided successful and significant pain relief on follow up.
Additional information: Intrathecal, chronic, pain
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