| Clinical Experience of Intrathecal Morphine Pump for Intractable Noncancerous Chronic Pain : 2 Cases |
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Su-Gi Jeon, Jeoung Hee Kim, Sang Ryong Jeon |
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Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea |
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| Abstract |
Introduction: The introduction of intrathecal opioid administration for intractable chronic non-cancerous pain and cancer pain
is considered as one of the most important breakthroughs in pain management. Morphine, the only opioid approved by FDA for
intrathecal administration, has been increasingly utilized for this purpose. The management of pain with oral or transdermal opioid analgesics can cause severe side effects. Continuous intrathecal administration of morphine via an implantable pump might
represent an alternative therapy to conventional oral or transdermal administration of opioids. We report two patients who were
implanted with an intrathecal infusion pump resulted in significant improvement of the patient’s pain and functional capacity.
Materials and Methods: Two patients who suffered from intractable severe post-traumatic pain were undergone intrathecal
morphine pump (implantable Medtronic® SynchroMed II® programmable infusion pump, Medtronic Inc., Minneapolis, MN.) The
catheter was inserted at lumbar 3-4 level, up to thoracic 10 level, and pump was installed at subcutaneous area of flank. The
procedure was performed by one stage operation. Clinical improvement was evaluated by pre-operative and post-operative
Numeric rating scale (NRS).
Results
A 40-years-old female with a 4-years history of severe back, pelvic pain, both arm and leg pain and headache after
traffic accident. The patient described her pain level was usually at 8-9/10 on a numeric pain scale of 0-10. After morphine
pump insertion, her pain level was at 6/10 on a numeric pain scale of 0-10. A 33-years-old female with a 3-years history of
severe back pain and left arm pain after epidural hematoma on T5-7 caused by traffic accident. The patient described her pain
level was usually at 7/10 on a numeric pain scale of 0-10. After morphine pump insertion, her pain level was at 4/10 on a
numeric pain scale of 0-10.
Conclusion
The utilization of intrathecal morphine pump for intractable severe chronic pain in two cases was effective for
pain management. In our clinical experience, as well as review of the literature, complications and side effects related to pump
implantation were minor and transient. We suggest that continuous intrathecal morphine treatment by pump is useful for
chronic noncancerous intractable pain patients. However, careful clinical application is needed. |
| Key Words:
Intrathecal morphine pump, Opioid, Intractable pain. |
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