The Use of Intrathecal Drug Delivery System to Manage Refractory Abdominal Pain From Systemic Amyloidosis

Systemic amyloidosis can cause severe refractory pain, often inadequately managed with conventional analgesics. Intrathecal drug delivery systems (IDDS) have been used for chronic pain control but are rarely reported in amyloidosis cases.

We present a female patient in her late 50s with systemic light-chain amyloidosis and type III intestinal failure, experiencing significant weight loss and debilitating abdominal pain during enteral and parenteral feeding. After unsuccessful trials of oral analgesics, antineuropathic medications, and interventional procedures, an IDDS was implanted to deliver a combination of bupivacaine and morphine. The therapy allowed her to resume enteral and parenteral nutrition, reduce opioid consumption, gain weight, improve functionality, and decrease hospital admissions despite disease progression.

This case highlights the efficacy of intrathecal analgesia in managing severe refractory pain from amyloidosis. Early consideration of IDDS may improve quality of life in similar patients by providing effective long-term pain control.