본문 바로가기
KERD
논문KCI 등재

복합부위통증증후군 환자에게 시행한 매몰식 펌프를 이용한 지주막하강 내 약물투입 −증례보고−

Implantable Intrathecal Drug Delivery Pump in Complex Regional Pain Syndrome Patient −A case report−

1

조회

0

다운로드

2

인용

0

참고문헌

키워드

초록

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8−10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 ㎎ of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 ㎎ in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

Abstract

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8−10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 ㎎ of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 ㎎ in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

참고문헌 (18)

  1. Galer BS, "Complex regional pain syndromes-type I: Reflex sympathetic dystrophy, and type II: Causalgia. In: Bonica's management of pain. 3rd ed", pp.388~411 (2001), Lippincott Williams & Wilkins
  2. Baron R, "Complex regional pain syndromes. In: Wall and Melzack's textbook of pain. 5th ed", pp.1011~1027 (2006), Elsevier Churchill Livingstone
  3. Pert CB, "Opiate receptor: demonstration in nervous tissue", Science, 179, pp.1011~1014 (1973)
  4. Ruan X, "Drug-related side effects of long-term intrathecal morphine therapy", Pain Physician, 10, pp.357~366 (2007)
  5. Burton AW, "Epidural and intrathecal analgesia is effective in treating refractory cancer pain", Pain Med, 5, pp.239~247 (2004)
  6. Simpson RK Jr, "Mechanisms of action of intrathecal medications", Neurosurg Clin N Am, 14, pp.353~364 (2003)
  7. Gilmer-Hill HS, "Intrathecal morphine delivered via subcutaneous pump for intractable cancer pain: a review of the literature", Surg Neurol, 51, pp.12~15 (1999)
  8. Koulousakis A, "Intrathecal opioids for intractable pain syndromes", Acta Neurochir Suppl, 97, pp.43~48 (2007)
  9. Krames ES, "Intraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines", J Pain Symptom Manage, 11, pp.333~352 (1996)
  10. Hassenbusch SJ, "Epidural and subarachnoid administration of opioids for nonmalignant pain: technical issues, current approaches and novel treatments", J Pain Symptom Manage, 11, pp.357~362 (1996)
  11. Sylvester RK, "The conversion challenge: from intrathecal to oral morphine", Am J Hosp Palliat Care, 21, pp.143~147 (2004)
  12. Jacobson L, "A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects", Anesth Analg, 67, pp.1082~1088 (1988)
  13. Belverud S, "Intrathecal pumps", Neurotherapeutics, 5, pp.114~122 (2008)
  14. Hassenbusch SJ, "Clinical realities and economic considerations: economics of intrathecal therapy", J Pain Symptom Manage, 14, pp.36~48 (1997)
  15. Krames ES, "Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine", J Pain Symptom Manage, 8, pp.539~548 (1993)
  16. Chaney MA, "Side effects of intrathecal and epidural opioids", Can J Anaesth, 42, pp.891~903 (1995)
  17. Bejjani GK, "Intrathecal granuloma after implantation of a morphine pump: case report and review of the literature", Surg Neurol, 48, pp.288~291 (1997)
  18. Kumar K, "Continuous intrathecal morphine treatment for chronic pain of nonmalignant etiology: long-term benefits and efficacy", Surg Neurol, 55, pp.79~86 (2001)

관련 논문AI추천

이 간행물의 다른 논문 (19건)