Another intriguing presentation at the 20th Annual Napa Pain Conference pre-conference meeting was Dr. Lawrence Poree’s topic entitled, “Prevention, Assessment and Management of Granuloma.” He presented case studies of patients who had experienced granulomas and discussed their clinical symptoms, diagnoses and resolution. One very interesting study in particular was of patients receiving morphine sulfate in conjunction with chromolin sodium intrathecally, or via subcutaneously, which demonstrated no inflammatory mass development. Dr. Poree also spoke of CSF protein content in normal patients as well as those with inflammatory masses ““ thus noting the differences. He expressed that more studies should occur to evaluate the CSF protein levels. He respectively asserted an opinion that CSF protein level may be an indicator for inflammatory masses.

He surmised his presentation to recommend the following considerations to avoid inflammatory mass formations: low dose medications, place catheter in a large space of the CSF, vigilant surveillance, routinely monitor and consider medication change if mass develops. This was a remarkable presentation, and I hope that I have the opportunity to discuss this topic further with Dr. Poree.