Open AccessComplications after Intrathecal Drug Delivery Due to the Underlying Malignancy in Two Patients with Intractable Cancer Pain
Author(s) -
Thomas Chai,
Brian M. Bruel,
Kent H. Nouri,
Larry C. Driver
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e107
Subject(s) - medicine , analgesic , cancer pain , perioperative , anesthesia , intractable pain , malignancy , cancer , surgery
Intrathecal drug delivery is a mode of analgesic delivery that can be considered in thoseexperiencing both refractory pain and excessive side effects from opioid and adjuvant analgesicuse. Delivery of analgesic agents directly to the cerebral spinal fluid allows binding of thedrug to receptors at the spinal level. Therefore, a reduced analgesic dosage can be afforded,resulting in reduction of drug side effects due to decreased systemic absorption. Drug deliveryinto the intrathecal space provides this benefit, yet it does not eliminate the possibility of drugside effects or risks of complications.Complications from this route of administration may be seen in the perioperative period orbeyond, including infection, inflammatory mass, bleeding, and catheter or pump dysfunction,among others. This may manifest as new/worsening pain or as a neurologic deficit, such asa sensorimotor change and bladder/bowel dysfunction. Urgent evaluation with a detailedphysical examination, device interrogation, and other workup including imaging is called forif symptoms suspicious for device-related problems arise. For the cancer pain patient, theunderlying malignancy should also be considered as a potential cause for these new symptomsafter intrathecal system implantation.We present 2 such cases of complications in the cancer pain patient after intrathecal drugdelivery due to progression of the underlying malignant process rather than to surgical ordevice-related problems. The first patient had a history of metastatic osteosarcoma who,shortly after undergoing an intrathecal drug delivery trial with external pump, presented withnew symptoms of both pain and neurologic changes. The second patient with a history ofchondrosarcoma developed new symptoms of pain and sensorimotor change several daysafter intrathecal drug delivery system implantation.Key words: Intrathecal analgesia, intrathecal drug delivery, perioperative complications,cancer pain, malignant pain, pain pump