Long-term intraspinal infusions of opioids in the treatment of neuropathic pain

• Published in: Journal of pain and symptom management Vol. 10; no. 7; pp. 527 - 543
• Main Authors: Hassenbusch, Samuel J., Stanton-Hicks, Michael, Covington, Edward C., Walsh, James G., Guthrey, Donna S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1995; Elsevier Science
• Subjects: Analgesia, Epidural; Analgesics; Analgesics, Opioid - therapeutic use; Biological and medical sciences; complications; Follow-Up Studies; Humans; Infusion Pumps, Implantable; intrathecal; Medical sciences; morphine; Neuralgia - drug therapy; neuropathic; Neuropharmacology; opioid; Pain; Pharmacology. Drug treatments; pump; sufentanil; Time Factors; neuropathic; sufentanil; intrathecal; Pain; complications; opioid; pump; morphine; Human; Drug combination; Chemotherapy; Treatment; Perfusion; Morphine; Opiates; Neuropathy; Narcotic analgesic; Long term; Intrathecal administration
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/0885-3924(95)00087-F

Long-term intraspinal infusions of opioid drugs are being increasingly utilized in patients with noncancer pain. Despite this, there is a lack of long-term information, including success and failure rates for pain relief and technical problems. During a 5-year period, 18 noncancer patients underwent implantation of programmable infusion pumps for long-term intrathecal opioid infusion. Patients had (a) neuropathic pain, (b) had failed or been ineligible for noninvasive treatments, and (c) obtained greater than 50% pain relief with intrathecal trial infusions of morphine sulfate or sufentanil citrate. A disinterested third-party reviewer evaluated patients at the most recent follow-up. Sixty-one percent (11/18) of patients had good or fair pain relief with mean follow-up 2.4 ± 0.3 years (0.8–4.7 years). Average numeric pain scores decreased by 39% ± 4.3%. Five of the 11 responders required lower opioid doses (12–24 mg/day morphine) and the remaining six patients required higher opioid doses (>34 mg/day morphine). Failure of long-term pain relief occurred in 39% (7/18) despite good pain relief in trial infusions and the use of both morphine and sufentanil. Technical problems developed in 6/18 patients but appeared to be preventable with further experience. Long-term intrathecal opioid infusions can be effective in treatment of neuropathic pain but might require higher infusion doses.