Introduction
Intrathecal pain pumps (IPP) are sometimes prescribed by pain medicine specialists for treatment of chronic nonmalignant pain. Urinary retention is a well-recognized side effect of opioids administration via IPP for chronic nonmalignant pain. Mild urinary retention, not requiring intervention, following intrathecal morphine administration has an estimated incidence of approximately 42% in nonmalignant pain patients1-3. Severe urinary retention in this context is less common. A large retrospective study on intrathecal morphine in 39 nonmalignant chronic pain patient describes a single case of severe urinary retention (2.6%) as a complication of intrathecal analgesia requiring system removal 4.
We were able to identify only one case report in the literature which focused on management strategies for resolving urinary retention secondary to IPP placement 5. In this case report, the urinary retention was resolved 4 days after reducing the morphine infusion rate by 75% from 2000 mcg / 24 hours to 500 mcg/ 24 hours5. We present our experience with a case of a neurogenic bladder which presented as severe urinary retention immediately following IPP placement for chronic peripheral neuropathy in an elderly female with multiple comorbidities. Dose reduction did not remedy the urinary retention. The urinary retention only improved after changing the type of narcotic infused.