OBJECTIVE: 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. DESIGN: 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. SETTING AND PATIENTS: 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. RESULTS AND CONCLUSIONS: 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.
OBJECTIVE: 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. DESIGN: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. SETTING AND PATIENTS: 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. RESULTS AND CONCLUSIONS: 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.
Authors: Derek G Southwell; Joseph A Osorio; Christopher S Liverman; Lauren M Friedman; Ramana K Naidu; Lawrence R Poree; Melanie M Henry; Line Jacques Journal: Surg Neurol Int Date: 2017-07-25
Authors: Jose De Andres; Salim Hayek; Christophe Perruchoud; Melinda M Lawrence; Miguel Angel Reina; Carmen De Andres-Serrano; Ruben Rubio-Haro; Mathew Hunt; Tony L Yaksh Journal: Front Pain Res (Lausanne) Date: 2022-06-16