Retrospective investigation of intermittent bolus intrathecal morphine for cancer pain patients.

Abstract

One hundred patients with intolerable cancer pain were treated with intrathecal bolus injections of morphine(IT morphine). The study began 2 days later after port-A cath implantation and continued during the 12 weeks follow-up period. During the investigation, the dosages, pain intensity, side effects, complications, activity and acceptibility were recorded. Initially, the morphine test does(0.2mg) resulted in pain relief for 8-26 hrs (mean 13.4 hrs). Then, changing the morphine dosages or frequency of injections were relied upon the effect of the opiate to provide 24 hrs pain relief. The mean morphine requirements were 0.32mg in 1st week, 0.44mg in 4th week, 1.25mg in 8th week and 1.43mg in 12th week. The mean morphine dose before IT treatment was 36.4mg. The vast majority of patients' pain intensity decreased prominently after IT morphine treatment. But pain was aggravated in the 12th week although the morphine dose increased. Side effects were minimal, and only one patient suffered from meningitis. Complications included 8 patients with port-A system dysfunction, one with anterior spinal artery syndrome, and one case of cauda equina syndrome. Activity improved significantly and all patients accepted the kind of treatment though some patients did not experience completely satisfactory relief from pain. Intrathecal morphine therapy uses only small amounts of opiate to achieve the optimal level of pain relief. So it offers a beneficial treatment option to patients whose pain has become intolerable or who have poor responsiveness to systemic narcotics.