A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain

Valerie Anderson, Kim Burchiel

Research output: Contribution to journalArticle

184 Citations (Scopus)

Abstract

OBJECTIVE: To examine in a prospective manner the long-term safety and efficacy of chronic intrathecal morphine in patients with severe, nonmalignant pain refractory to less invasive modalities. METHODS: Forty patients with severe, chronic nonmalignant pain poorly managed by systemic medications were identified as candidates for intraspinal trial of morphine. Thirty participants reported successful pain relief during trial and were implanted with an intraspinal delivery system. Standardized measures of pain and functional status were assessed before treatment was begun and at defined intervals during the subsequent 24 months. Intrathecal opioid use and pharmacological and device-related complications were also monitored. RESULTS: The participants had a mean age of 58 ± 13 years and a mean pain duration of 8 ± 9 years. Fifty-three percent of the study participants were women. Pain type was characterized as mixed neuropathic-nociceptive (15 of 30 patients, 50%), peripheral neuropathic (10 of 30 patients, 33%), deafferentation (4 of 30 patients, 13%), or nociceptive (1 of 30 patients, 3%). Forty-seven percent of the patients were diagnosed with failed back surgery syndrome. Significant improvement over baseline levels of visual analog scale pain was measured at each follow-up examination after implant. Overall, 50% (11 of 22 patients) of the population reported at least a 25% reduction in visual analog scale pain after 24 months of treatment. In addition, the McGill Pain Questionnaire, visual analog scale measures of functional improvement and pain coping, and several subscales of the Chronic Illness Problem Inventory showed improvement throughout the follow-up period. Pharmacological side effects were managed medically by morphine dose reduction, addition of bupivacaine, or replacement of morphine with hydromorphone. Device-related complications requiring repeat operations were experienced by 20% of the patients. CONCLUSION: Continuous intrathecal morphine can be a safe, effective therapy for the management of severe, nonmalignant pain among a carefully selected patient population and can result in long-term improvement in several areas of daily function.

Original languageEnglish (US)
Pages (from-to)289-301
Number of pages13
JournalNeurosurgery
Volume44
Issue number2
DOIs
StatePublished - Feb 1999

Fingerprint

Chronic Pain
Morphine
Prospective Studies
Pain
Pain Measurement
Equipment and Supplies
Failed Back Surgery Syndrome
Hydromorphone
Pharmacology
Intractable Pain
Bupivacaine
Visual Analog Scale
Opioid Analgesics
Population
Chronic Disease
Therapeutics
Safety

Keywords

  • Analgesia
  • Chronic pain
  • Intrathecal opioid
  • Morphine

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain. / Anderson, Valerie; Burchiel, Kim.

In: Neurosurgery, Vol. 44, No. 2, 02.1999, p. 289-301.

Research output: Contribution to journalArticle

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