Presented by:  Dr. Robert Griebel, Neurosurgeon, Saskatoon

Age:  47

Sex:  Female

History:

• 1993 - Underwent surgery on the L tibia for an osteiod oseoma.
• Postoperatively had burning leg pain and was assumed to have nerve damage at the time of surgery.
• 4 subsequent procedures failed to resolve the patient's burning, dysthetic pain in that limb.
• A spinal cord implant initially provided 80% relief but the benefit was transient and eventually ineffective.
• Pain was subsequently managed by large doses of narcotics.
•  1998 - Patient complained of a painful leg which was hypersensitive to light touch, movement and temperature change.
• Morphine pump was discussed and implanted after a successful trial of intrthecal drug and psychological testing.  
• Pain control was managed initially with 3mg daily.
• Patient continued to have a good control of leg pain with 7.5mg daily.
• 2001 - Patient has developed L sided (same side as leg pain) vulvodynia.
• Constant burning pain exacerbated by touch making intercourse impossible.
• Numerous gynecologic examinations and pelvic scans have failed to find an obvious cause for this.
• No benefit from Neurontin or Amitriptyline

Questions:

1. Change site of pump catheter?
2. Pudendal nerve block?
3. Change drug in pump?