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.