Intrathecal baclofen pump implantation for complex regional pain syndrome in a patient with a spinal cord stimulator: consideration about optimal location of intrathecal catheter tip - A case report -

Abstract

Complex regional pain syndrome (CRPS) is a chronic pain condition that most often affects one of the limbs, generally after an injury or trauma to that limb; it is characterized by pain and sensitivity, swelling, temperature and skin changes, and motor dysfunction in the affected area [1]. CRPS is associated with dysregulation of the central nervous system (CNS), peripheral nervous system, and autonomic nervous system. Intrathecal baclofen (ITB) pump implantation can be used to control dystonia and severe pain associated with complex regional pain syndrome (CRPS) with or without a spinal cord stimulator (SCS). A 45-year-old female patient had gotten an SCS to control the pain of CRPS. However, she suffered from chronic intractable pain in her left ankle and foot despite paresthesia in the entire painful area because the effectiveness of the SCS gradually diminished over time. In a trial of intrathecal drug administration, baclofen was superior to morphine for pain relief, had fewer side effects, and was superior in terms of patient satisfaction. To achieve the greatest degree of pain relief from the ITB pump, the tip of the intrathecal catheter was carefully placed in relation to the SCS. Over a oneyear follow-up period, the patient experienced mild pain without any adverse effects.