A 54-year-old female with chronic
failed back surgery syndrome and
pain in the back and the right leg was treated by chronic spinal
morphine administration by an external pump. After a positive test instillation over a 3-week period the spinal
catheter was removed. Within 24 h the patient developed
fever, leucocytosis, impaired sense of smell and
allodynia and hyperpathia in all 4 limbs.
Infection was excluded as a possible cause and a withdrawal after a second test period some weeks later reinitiated the symptoms. The symptoms vanished after restarting the
morphine administration. Finally, an internal Medtronic pump was implanted because the patient obtained good
pain relief with the test instillation. Good
pain relief could be obtained with the daily instillation of 5 mg
morphine intrathecally.
Fever, leucocytosis, impaired sense of smell,
allodynia and hyperpathia in the limbs reappeared a few weeks later. Evaluation showed
catheter migration out of the spinal canal.