Pain Physician. 2003;6:495-497, ISSN 1533-3159 Migrating Opiate Pump: Atypical Cause of Meralgia Paresthetica

Funding: There was no external funding in prepara-tion of this manuscript. This is a case report of a 60 year-old female who presented with pain on the an-terolateral aspect of her right thigh. The patient had a history of placement of a Drug Administration System (DAS, Opiate pump) in August, 1998 for chronic lumbar radiculopathy and a multiply operated on spine which she had suffered with since Oc-tober, 1991. She presented with the sub-acute onset of focal pain on the anterior as-pect of her right superior iliac crest region and dysesthesias on the anterolateral as-pect of her right thigh. There was no his-tory of recent trauma, worsening low back pain, or any other sensori-motor change. There was no history of anterior iliac crest bone graft for her spinal fusion and she had no anterolateral thigh symptoms relat-ed to her lumbar radiculopathy. Her neu-rological examination was signifi cant only for decreased sensation on the anterolater-al aspect of her right thigh. On abdominal examination the DAS pump was found at a low-lying location and was closely abutting the anterior and medial aspect of her superi-or iliac spine. She underwent revision of the DAS pump site with obliteration of the infe-rior and lateral aspect of the pump pocket. Her symptoms improved by 30 % immedi-ately and completely dissipated within two month following the procedure. This is the fi rst reported case of lateral femoral cutane-ous nerve neuropathy with DAS use. Rec-ognition of focal compressive neuropathy by distal migration of a DAS is important, as they are potentially treatable with rec-ognition