Long-term intrathecal (it) infusion of bupivacaine relieved intractable pain and spasticity in a patient with multiple sclerosis

There is no reliable method to relieve both 'refractory' pain and spasticity in patients with multiple sclerosis (MS). This paper reports on the long-term use of continuous intrathecal bupivacaine infusion in such a patient. The patient under study was a 56-year-old woman affected for 18 years by MS, unsuccessfully treated with analgesics, baclofen, opioids, peripheral neurolysis (obturator nerves, lumbar plexus) and six intrathecal neurolyses of the L4-S3 nerve roots, each time with 1.5 ml of 50% phenol in glycerol. Intrathecal baclofen was not considered (MS with bulbar location and neurogenic pains). An intrathecal catheter was inserted via the L3-L4 interspace and its tip was placed at the height of the T12-L1 intervertebral disc. An intrathecal infusion of 0.5% bupivacaine at a rate of 3 ml (= 15 mg)/day was started. The infusion rate was gradually increased from 20 mg on the first day to 95 mg/day after 68 days. The pain intensity decreased from a mean visual analogue score (VAS(mean)) of 7 before treatment to 1 (on a 0-10 scale) during the intrathecal treatment. The patient became free from pain and spasticity. No side-effects or complications were recorded. The treatment was given for 712 days, at which point the patient died (unrelated to the treatment). Intrathecal infusion of bupivacaine relieved 'refractory' spasticity and pain in a MS patient in whom administration of intrathecal baclofen was contraindicated and neurodestructive procedures had been inefficient.