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• W1968959545 abstract "An increasing number of sickle cell patients suffer chronic pain refractory to comprehensive medical management (CMM). The successful use of an intrathecal drug delivery system (IDDS) with Personal Therapy Manager (PTM) bolus has been studied in cancer patients whose pain was not controlled. We describe the similar use for a patient with chronic sickle cell pain refractory to CMM. Our case was a 19-year-old female with sickle cell disease suffering chronic low back pain and avascular necrosis of her hips and shoulders. Her opiate use included hydromorphone and oxycontin, however her pain was poorly controlled and required frequent hospital admissions for pain management. She was unable to tolerate fentanyl and methadone and had an allergy to morphine. Due to her chronic sickle cell pain and inability to tolerate additional medical therapy, an IDDS/PTM was considered. Prior to undergoing IDDS, an intrathecal opioid trial was performed with significant pain relief. After the trial, she underwent an IDDS/PTM placement in the OR. The needle entry was at L3-L4 while the catheter tip was advanced to T10. An intrathecal pump filled with hydromorphone was pocketed in the abdomen. Post-op she remained in the PACU, had pain relief with her continuous infusion and PTM doses. One week later she was followed up in clinic, but still required high dose PO opioids. Her IDDS/PTM was interrogated and showed no uses of the PTM feature. Her continuous hydromorphone dose was increased and she was re-educated on the PTM device. A week later she returned to the clinic. She had used the PTM, reduced her PO medication, and had effective pain relief. Our case not only demonstrates the successful use of an IDDS in a patient with chronic sickle cell pain, but shows the benefit of having a PTM feature to help monitor and adjust patient therapy. An increasing number of sickle cell patients suffer chronic pain refractory to comprehensive medical management (CMM). The successful use of an intrathecal drug delivery system (IDDS) with Personal Therapy Manager (PTM) bolus has been studied in cancer patients whose pain was not controlled. We describe the similar use for a patient with chronic sickle cell pain refractory to CMM. Our case was a 19-year-old female with sickle cell disease suffering chronic low back pain and avascular necrosis of her hips and shoulders. Her opiate use included hydromorphone and oxycontin, however her pain was poorly controlled and required frequent hospital admissions for pain management. She was unable to tolerate fentanyl and methadone and had an allergy to morphine. Due to her chronic sickle cell pain and inability to tolerate additional medical therapy, an IDDS/PTM was considered. Prior to undergoing IDDS, an intrathecal opioid trial was performed with significant pain relief. After the trial, she underwent an IDDS/PTM placement in the OR. The needle entry was at L3-L4 while the catheter tip was advanced to T10. An intrathecal pump filled with hydromorphone was pocketed in the abdomen. Post-op she remained in the PACU, had pain relief with her continuous infusion and PTM doses. One week later she was followed up in clinic, but still required high dose PO opioids. Her IDDS/PTM was interrogated and showed no uses of the PTM feature. Her continuous hydromorphone dose was increased and she was re-educated on the PTM device. A week later she returned to the clinic. She had used the PTM, reduced her PO medication, and had effective pain relief. Our case not only demonstrates the successful use of an IDDS in a patient with chronic sickle cell pain, but shows the benefit of having a PTM feature to help monitor and adjust patient therapy." @default.
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• W1968959545 date "2013-04-01" @default.
• W1968959545 modified "2023-10-18" @default.
• W1968959545 title "The use of intrathecal drug delivery system for chronic sickle cell pain" @default.
• W1968959545 doi "https://doi.org/10.1016/j.jpain.2013.01.663" @default.
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