Continuous Intrathecal Infusion of Opioid and Bupivacaine in the Treatment of Refractory Pain Due to Postherpetic Neuralgia: A Case Report

This report details the course of a 77‐year‐old patient suffering mild pain from operated tongue cancer and excruciating, intractable pain from thoracic (T6–T8) post‐herpetic neuralgia (PHN), The mouth pain was treated with nonopioid analgesics, as the patient had personal objections to opioid treatment. All the components of the pain from his PHN (continuous burning pain, intermittent lancinating stabbing pain, and tactile allodynia) were successfully treated with an Intrathecal Infusion of buprenorphine (0.03 mg/ml) and bupivacaine (4.75 mg/ml) administered via an externalized intrathecal catheter with the tip located at T9–T10 intervertebral disc. The treatment started three months after the appearance of the herpetic eruption and lasted 294 days until the patient died of malnutrition and the progression of his tongue cancer. During treatment, he experienced satisfactory pain relief from his PHN; the mean visual analogue scores (VASmean), recorded on a scale from 0 to 10, ranged from 1 to 2, compared to 9 to 10 before starting the intrathecal treatment. Analgesia was established with 0.2–0.315 mg/day of intrathecal buprenorphine and 90–100 mg/day of intrathecal bupivacaine. His undisturbed nocturnal sleep increased from 4 to 5–6 hours. The side‐effects from the bupivacaine (urine retention requiring insertion of an indwelling urinary catheter, paresthesias, and mild pareses) were recorded. The patient could ambulate without support while on 90–100 mg/day of intrathecal bupivacaine. During a series of high‐pressure oxygen treatments in a pressure chamber to treat an infection at the site of his tumor, the intrathecal infusion was interrupted. Thus, repeated observation of the intervals of severe pain and of analgesia were possible.