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

: BACKGROUND 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 chro-nic, 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 multidisciplinary 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 pro-blems 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.

[1]  T. Yaksh,et al.  Current and Future Issues in the Development of Spinal Agents for the Management of Pain , 2017, Current Neuropharmacology.

[2]  T. Yaksh,et al.  Primary Hydromorphone‐Related Intrathecal Catheter Tip Granulomas: Is There a Role for Dose and Concentration? , 2016, Neuromodulation : journal of the International Neuromodulation Society.

[3]  D. Caraway,et al.  Successful Discontinuation of Systemic Opioids After Implantation of an Intrathecal Drug Delivery System , 2015, Neuromodulation : journal of the International Neuromodulation Society.

[4]  Jessica Tsukanov,et al.  Intrathecal analgesia: time to consider it for your patient? , 2015, The Journal of family practice.

[5]  T. Holekamp,et al.  Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities: A Single-Institution Experience , 2014, Spine.

[6]  E. Sparkes,et al.  Long-term Intrathecal Drug Administration for Chronic Nonmalignant Pain , 2012, Journal of neurosurgical anesthesiology.

[7]  T. Deer,et al.  Inflammatory mass of an intrathecal catheter in patients receiving baclofen as a sole agent: a report of two cases and a review of the identification and treatment of the complication. , 2007, Pain medicine.

[8]  J. Turner,et al.  Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications , 2007, The Clinical journal of pain.

[9]  J. Bailes,et al.  A review of intrathecal morphine therapy related granulomas , 2006, European journal of pain.

[10]  G. Skaf,et al.  Baclofen pump pocket infection: a case report of successful salvage with muscle flap , 2006, International wound journal.

[11]  Ling Kh,et al.  Post-poliomyelitis syndrome : Case report and review of the literature , 2005 .

[12]  J. Daube,et al.  A 15-year follow-up of neuromuscular function in patients with prior poliomyelitis , 2005, Neurology.

[13]  L. J. Roberts,et al.  Sex Hormone Suppression by Intrathecal Opioids: A Prospective Study , 2002, The Clinical journal of pain.

[14]  E. Renard,et al.  Implantable insulin pumps: infections most likely due to seeding from skin flora determine severe outcomes of pump-pocket seromas. , 2001, Diabetes & metabolism.

[15]  A. Vaccaro,et al.  An association between the flat back and postpolio syndromes: a report of three cases. , 1997, Archives of physical medicine and rehabilitation.

[16]  B. Jubelt,et al.  Post-polio Syndrome: An Update , 1993, Seminars in neurology.

[17]  L. Kuller,et al.  Epidemiology of the post-polio syndrome. , 1992, American journal of epidemiology.

[18]  A. Rodriquez,et al.  Symptoms and clinical impressions of patients seen in a postpolio clinic. , 1989, Archives of physical medicine and rehabilitation.

[19]  Rossi Cd,et al.  New problems in old polio patients: results of a survey of 539 polio survivors. , 1985 .

[20]  J. O'Brien,et al.  Combined staged anterior and posterior correction and fusion of the spine in scoliosis following poliomyelitis. , 1975, Clinical orthopaedics and related research.

[21]  S. Hayek,et al.  Intrathecal Therapy for Chronic Pain: Current Trends and Future Needs , 2013, Current Pain and Headache Reports.

[22]  A. Gawne,et al.  Post-Polio Syndrome: Pathophysiology and Clinical Management , 1995 .