Painful Arachnoiditis

We have been treating via an implanted intrathecal pump an 11-year-old boy with VATER syndrome and disabling pain caused by arachnoiditis. Before implantation, he was bedbound and stuporous. For the past 2 years, intrathecal morphine and bupivacaine have yielded the following outcomes:

1. Regular attendance at school, with awards for being the most improved student in mathematics.

2. Participation in chores at home.

3. Recreational physical activity such as baseball and snorkeling. Conclusion

Regional anesthetic techniques have been wrongly perceived as dangerous for children. Moreover, there are few data about the outcomes of such treatment. Children inherently differ from adults in outcome measures that require assessment. It is also difficult to subject "soft" but vital results such as quality of life and parental satisfaction to classical outcomes analysis. As a result, physicians initially resorted to interventional techniques only in the most desperate cases involving children with intractable cancer pain who had nothing left to lose. Quality of life improved so much that we have started to use these techniques for patients whose disease courses are also fatal but less predictable. Interventional techniques are still underused for children with diseases such as HIV and CF. Palliative care is just beginning to embrace children whose quality of life is poor, but whose lifespans are indefinite. Interventional techniques may also be appropriate for these children. In all cases, outcomes have included qualitatively different and better analgesia, improved mood and social interaction, better respiratory function, freedom from opioid side effects, and parental satisfaction. Healthy children with painful problems that defy medical management also seem to benefit from interventional treatment, which can free them to enjoy a normal childhood and a productive adulthood. Finally, children with previously unmanageable spasticity often find easier care and better function with interventional techniques such as intramuscular botulinum toxin and intrathecal baclofen.™ 1111 ™ ™ ™

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