A CASE OF UNCOMMON WITHDRAWAL SYMPTOMS AFTER A SHORT-PERIOD OF SPINALMORPHINE ADMINISTRATION

A 54-year-old female with chronic failed back surgery syndrome and pai n in the back and the right leg was treated by chronic spinal morphine administration by an external pump. After a positive test instillatio n over a 3-week period the spinal catheter was removed. Within 24 h th e patient developed fever, leucocytosis, impaired sense of smell and a llodynia and hyperpathia in all 4 limbs. Infection was excluded as a p ossible cause and a withdrawal after a second test period some weeks l ater reinitiated the symptoms, The symptoms vanished after restarting the morphine administration. Finally, an internal Medtronic pump was i mplanted because the patient obtained good pain relief with the test i nstillation. Good pain relief could be obtained with the daily instill ation of 5 mg morphine intrathecally. Fever, leucocytosis, impaired se nse of smell, allodynia and hyperpathia in the limbs reappeared a few weeks later, Evaluation showed catheter migration out of the spinal ca nal.