Introduction. At the present time, there is no reliable method or
drug for effective relief of the severe
pain caused by the amyloldotic
polyneuropathy (AP). Objective. To explore the possibility of relieving this type of
pain by intrathecal (IT) infusion of
opioid (
morphine or
buprenorphine), with or without
bupivacaine. Patients, Materials and Methods. A 49-year-old male AP patient with
Intractable pain in the low back, lower abdomen, and lower extremities.
Opioids (up to 20 mg parenteral
morphine-eq/day), and
epidural injections of
morphine (up to 36 mg/day) failed to provide long-term satisfactory
pain relief. Therefore, an IT
catheter was inserted via the L3-L4 interspace with its tip located at the L1-L2 intervertebral disk. Results. Intermittent IT
injections of
morphine from 5 to 30 mg per day, for 124 days, and continuous IT infusion of
morphine (2-4 mg/ml), combined with
bupivacaine (1.0-2.0 mg/ml), in daily rates from 2 to 12 ml (median = 9.5) for another 67 days, were associated with occurrence of
seizures, suspected to be caused by the IT
morphine. Therefore, the IT
morphine was replaced with IT
buprenorphine. Thereafter, the
pain was treated with IT infusion of
buprenorphine (0.06 mg/ml) and
bupivacaine (1.25 mg/ml) in daily rates from 4 to 13 ml (median = 5) for another 676 days, until the patient's death, for reasons unrelated to the IT treatment. He experienced satisfactory
pain relief with daily doses of IT
opioid from 4.5 to 39 mg
morphine-eq (median = 19.6 mg) and IT
bupivacaine from 0 to 20 (median = 12.5). The mean visual Analog Scores (VASmean), decreased from 7 to 0 (out of 10), the gait improved; and nocturnal sleep increased from 1 to 7-8 hours.
Respiratory insufficiency (attributed to an an IT daily dose of ∼ 5 mg
morphine) and
orthostatic hypotension,
pareses, and
urinary retention occurring at low doses of (12-18 mg/day) of IT
bupivacaine were recorded. The patient had the IT treatment for 867 days, of which 777 days (> 90%) were spent at home. Conclusion. Long-term IT administration of
opioid and
bupivacaine provided satisfactory long-term
pain relief in a patient with
refractory pain due to AP.