HIGHLIGHTS
A case report of a patient with a rare and potentially fatal allergic condition, the DRESS Syndrome, and refractory peripheral neuropathy;
Morphine via epidural and later subarachnoid was used with satisfactory pain control, a treatment that is not considered frst-line;
Discussion of the mechanism of action of epidural and subarachnoid opioids in neuropathies.
ABSTRACT
BACKGROUND AND OBJECTIVES:
Peripheral neuropathy is a rare condition with many etiologies. Common symptoms are numbness, paresthesia, weakness and neuropathic pain. Treatment consists in frst-line agents such as anticonvulsants and some antidepressants. Te aim of this study was to report a case of chronic pain refractory to several therapies in a patient with absolute contraindication to the use of all anticonvulsants and antidepressants drugs.
CASE REPORT:
Female patient, a 40-year-old treated for trigeminal neuralgia with decompression that developed chronic occipital pain refractory to radiofrequency and onset of transient and bilateral T4 sensory and motor polyneuropathy after viral meningitis. In addition, she showed a severe pharmacodermy (Drug Rash with Eosinophilia and Systemic Symptoms- DRESS Syndrome) after using carbamazepine and other anticonvulsants, as well as allergy to all analgesics and opioids except morphine. Epidural puncture with insertion of a catheter was performed aiming at a 5-day test through intermittent epidural morphine bolus to assess the possibility of morphine pump implantation.
CONCLUSION:
The test was successful and the patient referred to the neurosurgery team. At the 6-month follow-up after the insertion of the morphine intrathecal pump, the strategy has proven to be efective in controlling pain secondary to polyneuropathy.
Keywords:
Analgesia; Drug hypersensitivity; Epidural; Morphine; Peripheral nervous system diseases; Syndrome; Trigeminal neuralgia