Intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol

Pain Medicine : the Official Journal of the American Academy of Pain Medicine
José De AndrésAna Mínguez

Abstract

Intrathecal granuloma associated to the tip of subarachnoid catheters implanted in patients receiving long-term spinal infusion is a rare but potentially catastrophic complication. Its development seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. Morphine or hydromorphone-related granulomas have been reported extensively in the literature, but there are no data about any of the other opioids currently used in an off-label fashion when first-line drugs are contraindicated. In this case, we report the first documented case of intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol, and we put forward a hypothesis for its development. Chronic intrathecal administration of high-dose tramadol could cause an inflammatory mass as it can be caused by similar, off-label infusions of morphine or hydromorphone. Additionally, tramadol stimulates the activity of natural killers and the proliferation of lymphocytes.

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Citations

Aug 22, 2013·International Journal of Obstetric Anesthesia·A SubediK Pokharel
Apr 13, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Nov 8, 2011·Clinical Neurology and Neurosurgery·Nestor D TomyczJohn J Moossy
Jan 31, 2013·Pain Practice : the Official Journal of World Institute of Pain·Samer N NarouzeDmitri Souzdalnitski
Feb 27, 2018·Pain Practice : the Official Journal of World Institute of Pain·Alexander J KimDavid Calligaris
Jan 4, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail

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