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Case 4 History |
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Presented by: Dr. Kris Kumar Neurosurgeon, Regina |
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Age: 65 Sex: Female History: 1976 - L4-5 disc fusion. Good result. 1993 - Developed back and bilateral leg pain. 1994 - As lumbar spine showed multi-level degenerative disease fusion done from L3 to S1. No benefit. 1996 - Bone scan negative. Fusion solid. CT negative. No disc of stenosis. 1998 - Pain Clinic - Multiple blocks. No benefit. By noe on narcotics, MS contin, 30 mg t.i.d.; Hydromorph, 30 mg b.i.d.; Diazepam, 10mg b.i.d. Had associated hypertension and hyperthyroidism. Trial of chair-back brace - No benefit. March, 2000 - A trial of intrathecal morphine 0.7 mg o.d. in bolus form - Pain relief. However, on a longer trial of intrathecal morphine using CAD pump even when the dose was increased to 3 mg a day no pain control. April, 2000 - Trial of intrathecal hydromorph bolus 0.18 mg o.d. - Pain control. Therefore a synchromed pump implanted but even on raising the daily dose to 0.97 mg a day poor pain control. Drug holiday did not help. Repeat trial of bolus hydromorphine through lumbar puncture - achieved pain control again. September, 2000 - The intrathecal catheter and pump explored - no abnormality found. However, on restarting the pump again poor pain control. November, 2000 - Pump stopped. |
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