• José De Andrés, José Tatay Vivò, Stefano Palmisani, Vicente L Villanueva Pérez, and Ana Mínguez.
• Department of Anesthesia, Critical Care and Multidisciplinary Pain Management, General University Hospital, Valencia, Spain. deandres_jos@gva.es
• Pain Med. 2010 Jul 1;11(7):1059-62.

ObjectiveIntrathecal granuloma associated to the tip of subarachnoid catheters implanted in patients receiving long-term spinal infusion is a rare but potentially catastrophic complication. Its development seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency.DesignMorphine or hydromorphone-related granulomas have been reported extensively in the literature, but there are no data about any of the other opioids currently used in an off-label fashion when first-line drugs are contraindicated.Setting And PatientsIn this case, we report the first documented case of intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol, and we put forward a hypothesis for its development.Results And ConclusionsChronic intrathecal administration of high-dose tramadol could cause an inflammatory mass as it can be caused by similar, off-label infusions of morphine or hydromorphone. Additionally, tramadol stimulates the activity of natural killers and the proliferation of lymphocytes.

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