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

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...

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Bibliographic Details
Published inJournal 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
LanguageEnglish
Published New York, NY Elsevier Inc 01.10.1995
Elsevier Science
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Summary: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.
Bibliography:ObjectType-Article-2
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ISSN:0885-3924
1873-6513
DOI:10.1016/0885-3924(95)00087-F