Inflammatory Granuloma Definition

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Inflammatory Granuloma - Definition for Patients and the Non-Medical Person

Inflammatory granuloma is a (possible) problem that may occur after you have a drug delivery system (morphine pump) implanted in your spine. This complication, while rare, is a result of of the surgical procedure.

The good news is that only about 1% of implanted drug delivery system patients (who are therefore at risk for inflammatory granuloma) actually develop the condition.

The term inflammatory granuloma describes the formation of an inflamed mass of tissue right where the catheter is inserted during the procedure.

Inflammatory granuloma occurs more frequently when the drug delivery system is implanted in the intrathecal space (a space that is located inside the layers of the spinal cord), as opposed to the epidural space (which is located on the outside.) 

Signs and Symptoms of Inflammatory Granuloma

Some of the early signs of inflammatory granuloma include loss of sensation and pain in the dermatome that corresponds to the level of the spinal cord where the catheter Is inserted. Later signs include paralysis and bowel and/or baldder dysfunction. If your doctor determines that you have inflammatory granuloma, she will likely stop the drug delivery immediately, and you may also need surgery.

According to Dr. Sudhir Diwan, director of the division of pain medicine at Weil-Cornell Medical College, inflammatory granuloma can present itself for up 6 months after the catheter has been placed.

But it also may take years before there are symptoms. Dr. Diwan says that inflammatory granuloma is related to the dosage or concentration of morphine delivered by the pump. He adds, "we like to place the catheter lower down, below the L-1 vertebra , as there is no spinal cord in that area, which minimizes injury."

How to Prevent Inflammatory Granuloma

Prevention of inflammatory granuloma may be accomplished by changing the medications delivered by the pump, using more than one area for catheter insertion and/or by not allowing dosages of morphine and hydromorphone to get too high.

Should you Have a Drug Pump Put In?

Drug pumps are generally a last resort type of treatment for chronic neck or back pain.  So they work? Maybe, maybe not.  I may depend on the type of pain you have. A  2014 article published in the Journal of Pain Research found that drug pumps implanted for the long term relief of non-cancer pain were not well supported by evidence - but that drug pumps that deliver the medication baclofen to help reduce spasticity (caused by spinal cord injury) were.

Sources:

Bottros, M., Christo, P. Current perspectives on intrathecal drug delivery. J Pain Res. July 2014. Accessed: Oct. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227625/

Sudhir Diwan, S., MD. Director, Pain Medicine Fellowship Program and Director, Division of Pain Medicine at Weil-Cornell Medical College of Cornell University. Telephone Interview. May 2008.

Patrick J. McIntyre, MD, JD; Timothy R. Deer, MDb; and Salim M. Hayek, MD, PhD. Complications of spinal infusion therapies Techniques in Regional Anesthesia and Pain Management Volume 11, Issue 3, July 2007, Complications of Interventional Pain Procedures.

Stedman's Medical Dictionary. 28th ed. Lippincott Williams & Wilkins. Baltimore. 2006.

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