Increasing back and radicular pain 2 years following intrathecal pump implantation with review of arachnoiditis.

BACKGROUND: Implanted intrathecal drug delivery pumps are now regularly used for the treatment of chronic benign and cancer-related pain that is refractory to conservative treatment methods. In most cases, the pumps are successful at reducing the intensity of pain and improving function and quality of life for pain patients. Limited studies have discussed the complications associated with intrathecal pump placement. SETTING: Academic tertiary care center. SUMMARY: We describe an unusual case of a patient who presented with progressive weakness and worsening lumbar and lower extremity pain following implantation of an intrathecal drug delivery system (IDDS). Work-up for the patient's symptoms includes a magnetic resonance imaging, which revealed lumbar arachnoiditis. Patient underwent a laminectomy and detethering of spinal cord and nerve roots below level of catheter insertion. There was transient improvement in her pain and weakness. Subsequent surgery for pump explantation revealed a retained Touhy introducer needle from her pump placement procedure. CONCLUSION: The entire IDDS was removed including the retained Touhy introducer needle. The patient later went on to receive a successful spinal cord stimulator trial and implantation with moderate relief of her chronic pain.

Management of chronic pain in a patient with autosomal dominant polycystic kidney disease by sequential celiac plexus blockade, radiofrequency ablation, and spinal cord stimulation.

Chronic pain frequently is associated with autosomal dominant polycystic kidney disease and is a significant cause of morbidity. The classic approach to treat pain in patients with this disease starts with nonpharmacologic therapy and progresses to high-dose opioid therapy and more invasive procedures, including surgery. We present the case of a 43-year-old white woman presenting in our clinic with poorly controlled chronic left flank and epigastric pain secondary to autosomal dominant polycystic kidney disease despite high-dose opioids and multiple cyst decompression procedures. After temporarily successful management with celiac plexus neurolysis and intercostal nerve radiofrequency ablations for years, the next more permanent step was dorsal column neurostimulation, affording excellent analgesia with significantly improved quality of life to this day.

Advancements in the management of urologic chronic pelvic pain: what is new and what do we know?

Prostatitis is one of the most common urologic diagnoses in men of all ages. The etiology of this problem remains poorly understood. No uniform solitary treatment is known for chronic prostatitis. As a result, a multimodal approach is most likely to demonstrate benefit for this disease. Various treatment modalities have included the use of both pharmacologic and nonpharmacologic treatments. In addition, multiple interventional techniques including the injection of botulinum toxin, transurethral needle ablation of the prostate, microwave thermotherapy, neuromodulation, and, most recently, extracorporeal shockwave therapy have been utilized with varying degrees of benefit.