Presented by:  Dr.Kris Kumar Neurosurgeon, Regina

Age:  66

Sex:  Female

History:

• 1976, 1994 Laminectomies

• 1995 Back Pain persists.

• 1996:  Spinal Fusion.  No relief.

• 1998:  INVESTIGATIONS ++. NORMAL

• Morphine pump proposed.

• March 2000:  Intrathecal morphine - Poor response.

• Hydromorph - good response.

• June 2000:  SYNCHROMED PUMP IMPLANTED

                -  Hydromorph 0.312mg/day

                -  No pain relief.  Swolen feet.

                -  Hydromorph 1.1mg/day.  No pain relief.

                -  Pump checked.  Working well.

Dye shows the pump to be PATENT

2001

• Pump stopped.
• Dilaudid bolus intrathecally.  - good pain relief
• Pump restarted.  No pain relief.  Swollen feet.
• Pump stopped.

Questions:

1.  Why is there a discrepency between intrathecal delivery through pump and direct bones?

2.  Now what?