Successful treatment of erythromelalgia with intrathecal hydromorphone and clonidine.
The objective of this study was to determine if intractable pain from erythromelalgia could be successfully treated with intrathecal hydromorphone and clonidine. A single case of pain from erythromelalgia refractory to multiple treatment modalities was examined and treated. The setting is an outpatient pain clinic at a major university teaching hospital. Our patient is an 82-year-old woman with hypertension and peripheral vascular disease. Intrathecal opioid and an alpha2-agonist were administered. Outcome was determined by means of patient self-report during office follow-up visits. Administration of intrathecal opioid and an alpha2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.