Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report

Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report

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ABSTRACT BACKGROUND AND OBJECTIVES: Peripheral neuropathy is a rare condition with many etiologies. Common symptoms are numbness, paresthesia, weakness and neuropathic pain. Treatment consists in frst-line agents such as anticonvulsants and some antidepressants. Te aim of this study was to report a case of chronic pain refractory to several therapies in a patient with absolute contraindication to the use of all anticonvulsants and antidepressants drugs. CASE REPORT: Female patient, a 40-year-old treated for trigeminal neuralgia with decompression that developed chronic occipital pain refractory to radiofrequency and onset of transient and bilateral T4 sensory and motor polyneuropathy after viral meningitis. In addition, she showed a severe pharmacodermy (Drug Rash with Eosinophilia and Systemic Symptoms- DRESS Syndrome) after using carbamazepine and other anticonvulsants, as well as allergy to all analgesics and opioids except morphine. Epidural puncture with insertion of a catheter was performed aiming at a 5-day test through intermittent epidural morphine bolus to assess the possibility of morphine pump implantation. CONCLUSION: The test was successful and the patient referred to the neurosurgery team. At the 6-month follow-up after the insertion of the morphine intrathecal pump, the strategy has proven to be efective in controlling pain secondary to polyneuropathy.

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Autores principales: Valente,Julie Azevedo Araújo, Siqueira,Bárbara Caroline, Martins,Marcelo de Jesus, Sampaio Filho,Antonio Argolo
Formato: Digital revista
Idioma:English
Publicado: Sociedade Brasileira para o Estudo da Dor 2022
Acceso en línea:http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2595-31922022005007201
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spelling oai:scielo:S2595-319220220050072012022-12-20Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case reportValente,Julie Azevedo AraújoSiqueira,Bárbara CarolineMartins,Marcelo de JesusSampaio Filho,Antonio Argolo Analgesia Drug hypersensitivity Epidural Morphine Peripheral nervous system diseases Syndrome Trigeminal neuralgia ABSTRACT BACKGROUND AND OBJECTIVES: Peripheral neuropathy is a rare condition with many etiologies. Common symptoms are numbness, paresthesia, weakness and neuropathic pain. Treatment consists in frst-line agents such as anticonvulsants and some antidepressants. Te aim of this study was to report a case of chronic pain refractory to several therapies in a patient with absolute contraindication to the use of all anticonvulsants and antidepressants drugs. CASE REPORT: Female patient, a 40-year-old treated for trigeminal neuralgia with decompression that developed chronic occipital pain refractory to radiofrequency and onset of transient and bilateral T4 sensory and motor polyneuropathy after viral meningitis. In addition, she showed a severe pharmacodermy (Drug Rash with Eosinophilia and Systemic Symptoms- DRESS Syndrome) after using carbamazepine and other anticonvulsants, as well as allergy to all analgesics and opioids except morphine. Epidural puncture with insertion of a catheter was performed aiming at a 5-day test through intermittent epidural morphine bolus to assess the possibility of morphine pump implantation. CONCLUSION: The test was successful and the patient referred to the neurosurgery team. At the 6-month follow-up after the insertion of the morphine intrathecal pump, the strategy has proven to be efective in controlling pain secondary to polyneuropathy.info:eu-repo/semantics/openAccessSociedade Brasileira para o Estudo da DorBrJP n.ahead 20222022-01-01info:eu-repo/semantics/reporttext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2595-31922022005007201en10.5935/2595-0118.20220041-en
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libraryname SciELO
language English
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author Valente,Julie Azevedo Araújo
Siqueira,Bárbara Caroline
Martins,Marcelo de Jesus
Sampaio Filho,Antonio Argolo
spellingShingle Valente,Julie Azevedo Araújo
Siqueira,Bárbara Caroline
Martins,Marcelo de Jesus
Sampaio Filho,Antonio Argolo
Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
author_facet Valente,Julie Azevedo Araújo
Siqueira,Bárbara Caroline
Martins,Marcelo de Jesus
Sampaio Filho,Antonio Argolo
author_sort Valente,Julie Azevedo Araújo
title Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
title_short Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
title_full Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
title_fullStr Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
title_full_unstemmed Epidural morphine for chronic pain in a patient with peripheral neuropathy and DRESS syndrome. Case report
title_sort epidural morphine for chronic pain in a patient with peripheral neuropathy and dress syndrome. case report
description ABSTRACT BACKGROUND AND OBJECTIVES: Peripheral neuropathy is a rare condition with many etiologies. Common symptoms are numbness, paresthesia, weakness and neuropathic pain. Treatment consists in frst-line agents such as anticonvulsants and some antidepressants. Te aim of this study was to report a case of chronic pain refractory to several therapies in a patient with absolute contraindication to the use of all anticonvulsants and antidepressants drugs. CASE REPORT: Female patient, a 40-year-old treated for trigeminal neuralgia with decompression that developed chronic occipital pain refractory to radiofrequency and onset of transient and bilateral T4 sensory and motor polyneuropathy after viral meningitis. In addition, she showed a severe pharmacodermy (Drug Rash with Eosinophilia and Systemic Symptoms- DRESS Syndrome) after using carbamazepine and other anticonvulsants, as well as allergy to all analgesics and opioids except morphine. Epidural puncture with insertion of a catheter was performed aiming at a 5-day test through intermittent epidural morphine bolus to assess the possibility of morphine pump implantation. CONCLUSION: The test was successful and the patient referred to the neurosurgery team. At the 6-month follow-up after the insertion of the morphine intrathecal pump, the strategy has proven to be efective in controlling pain secondary to polyneuropathy.
publisher Sociedade Brasileira para o Estudo da Dor
publishDate 2022
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2595-31922022005007201
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