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Related Experiment Videos

Progressive systemic sclerosis: intrathecal pain management

C N Lundborg1, P V Nitescu, L K Appelgren

  • 1Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

Regional Anesthesia and Pain Medicine
|February 10, 1999
PubMed
Summary

Intrathecal buprenorphine/bupivacaine infusion effectively managed severe pain in a progressive systemic sclerosis patient with Raynaud's phenomena. This treatment significantly improved quality of life and pain relief over 861 days.

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Area of Science:

  • Neurology
  • Pain Management
  • Pharmacology

Background:

  • Severe pain from progressive systemic sclerosis (PSS) with Raynaud's phenomena and limb ischemia lacks effective long-term treatment.
  • Previous conservative treatments, including opioids and spinal cord stimulation, failed to provide adequate relief.

Observation:

  • A 71-year-old female patient with intractable lower extremity pain due to PSS and Raynaud's phenomena received continuous intrathecal (IT) buprenorphine/bupivacaine analgesia.
  • The IT treatment involved a bupivacaine and buprenorphine infusion via a patient-controlled intrathecal analgesia pump.
  • Dosage was adjusted to achieve 80-100% pain relief, with a mean bupivacaine dose of 18.6 mg/day.

Findings:

  • The IT therapy provided sustained 90-100% pain relief for 861 days, significantly improving the patient's quality of life and sleep duration.

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  • Treatment complications included transient post-dural puncture headache and meningitis, both successfully managed.
  • Exceeding 20 mg/day of IT bupivacaine resulted in transient neurological side effects like urinary retention and reduced motor strength.

    • Implications:

    • Continuous intrathecal buprenorphine/bupivacaine infusion is a viable long-term strategy for managing intractable ischemic pain in PSS patients.
    • This approach offers significant pain reduction and functional improvement, enhancing patient quality of life.
    • Careful dose titration is crucial to avoid adverse neurological effects associated with higher bupivacaine concentrations.