Prolonged administration of intratecal morphine by infusion pump implanted in a case of non-oncological chronic pain
Abstract
INTRODUCTION: The evolution of a patient who was implanted with an intrathecal infusion pump of morphine 14 years ago is described for the treatment of chronic lumbar pain post-laminectomy.
MATERIAL AND METHOD: It required the administration of 60 mg / day of subcutaneous morphine that caused side effects that did not tolerate, and multiple hospitalizations for pain control. He was implanted with a continuous infusion pump (Isomed) connected to a subarachnoid catheter, which releases 1 ml / day, and needs to be filled every 60 days.
RESULTS: An average pain decrease of 50% per year, and 75% at 6 and 12 years was observed. It required a progressive increase in filling doses, which went from 30 mg of morphine (0.5 mg / day) at the beginning, to 40 mg of morphine (0.66 mg / day per year, to 70 mg of morphine (1.16 mg / day) at age 6, at 140 mg (2.33 mg / day) at age 14. No serious medical complications were recorded, he maintained constipation and sweating throughout the period, and installed secondary hypogonadism with libido and erection disorders, that were corrected with the administration of testosterone. No further hospitalizations were required due to pain. No complications were observed related to the operation or filling of the pump or linked to the catheter. The patient stated that he was satisfied with the implant.
DISCUSSION: Despite the increase in filling doses, expression of tolerance development, the required morphine / day doses are frankly below the recommended limit.
CONCLUSIONS: The cost-effectiveness balance of the implant was positive, considering the best pain control, the lowest doses used, the absence of serious complications, and the lack of hospitalizations for pain control.
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References
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