Successful Treatment of Erythromelalgia With Intrathecal Hydromorphone and Clonidine

Abstract

Administration of intrathecal opioid and an alpha2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.

Erythromelalgia

“…Lidocaine patch [23] 1 Intravenous lidocaine followed by oral mexiletine [24] 1 Bupivocaine intermittent [25] 1 Lumbar epidural infusion with bupivacaine/fentanyl [26] 1 Cervical epidural infusion with bupivacaine/morphine sulfate and bupivacaine/meperidine [27] 2 Cervical epidural (morphine and bupivacaine) [28] 1 Opioid/opioid agonist Buprenorphine [29] NS Intrathecal hydromorphone and clonidine (α2 agonist) [30] 1 Benzadiazepine (clonazepam) [31] 1 Antihistamines (cyproheptidine) [32] 2 Nonsteroidal anti-inflammatory drugs (piroxicam) [33] 1 Ergot alkaloids Methysergide maleate [34] 1 Methysergide and aspirin [35] 1 Pizotifene [15,36,37] 5 Systemic corticosteroids Prednisone [38] 1 Prednisolone, phenoxybenzamine [39] 1 Growth hormone [40] 1 Magnesium [41] 1 Combination treatment Aspirin, carbamezapine, and propranolol [42] 1 Systemic corticosteroids and pentazocine [43] 1 Sympathectomy and sympathetic nerve blocks Sympathectomy and sympathetic nerve blocks [44,45] 6 Lumbar sympathetic block and total spinal block [46] 1 Lumbar sympathetic ganglion block [47] 1 Lumbar sympathetic blocks [48] 3 Other therapies Hypnotherapy [49] 1 Spinal cord stimulation [50] 1 Neurosurgery…”

Novel Polymeric Bioerodable Microparticles for Prolonged-Release Intrathecal Delivery of Analgesic Agents for Relief of Intractable Cancer-Related Pain

“…For moderate to severe post‐operative pain, administration of strong opioid analgesics such as morphine or its fivefold more potent analogue, hydromorphone by the i.t. route, often produces excellent analgesia . However, there are only a few case reports where i.t.…”

Secondary erythromelalgia successfully treated with patient-controlled epidural analgesia and interferon α-2b: A case report and review of the literature

“…A possible explanation may be sympathetic denervation, which improved the blood flow to the skin at the capillary level, thus reversing the chronic ischemic status secondary to increased arteriovenous shunting triggered by hypersensitive PLT-mediated arteriolar thrombosis. This explanation is supported by successful outcomes of other similarly aggressive techniques, including intrathecal infusion and sympathetic ganglion block, the therapeutic effects of which are mediated through inhibition of the sympathetic nerves (5,6). Further histological and physiological studies of autonomic nerve function in patients with SEM are required to illustrate whether SEM is sympathetically mediated.…”

“…Although several therapeutic options exist, including conservative treatments such as aspirin, serotonin reuptake inhibitors, tricyclic antidepressants and anticonvulsants, and invasive approaches including performing a sympathetic block or sympathectomy, no method is consistently effective in managing the various symptoms (3). Previous investigations of EM reported prolonged remission of symptoms with epidural infusions, intrathecal infusion and sympathetic ganglion block with local anesthetics (4)(5)(6). Polycythemia vera (PV) is a myeloproliferative disease, which is occasionally accompanied by cutaneous manifestations, including EM (7).…”