Intrathecal therapy: rationale, technique, clinical results

Abstract

In 35 patients a subcutaneously implanted injection port/reservoir was used to provide intrathecal morphine to relieve pain due to cancer. The reservoir offers an alternative to rather expensive devices. It can be used for repeated injections or for infusion. It is easy to locate and facilitates ambulatory treatment. The injections were carried out by members of the patient's family after they had been taught how to do it. Initially, doses of 0.25–0.5 mg of morphine resulted in pain relief for 14 to 24 hours. After 5 weeks of treatment morphine requirements increased to 0.75–2 mg. Side‐effects were minimal, and three delayed CSF fistula, two of them confirmed by isotope tracking with Tc99m, closed spontaneoulsy.

Intrathecal pumps for giving opioids in chronic pain: a systematic review.

“…Fortunately it is often only transient. 48,84 Cheng and colleagues 24 reported an incidence of 36% during the first week and 0% after week 2 of intrathecal morphine therapy. • In general, pruritus is uncommon in chronic administration of morphine.…”

Repeated Morphine Administration Increases TRPV1 mRNA Expression and Autoradiographic Binding at Supraspinal Sites in the Pain Pathway

“…Repeated morphine administration induces tolerance in animals and humans regardless of the administration route (Cichewicz and Welch, 2003;Younger et al, 2008). Tolerance to morphine analgesia develops at peripheral, spinal, and supraspinal sites (Leavens et al, 1982;Madrid et al, 1987;Kolesnikov et al, 1996;Ness and Follett, 1998;Kest and Hopkins, 2001;Bao et al, 2015) through complex mechanisms that are not fully understood. Numerous studies have indicated that the activation of pronociceptive chemicals contributes to morphine tolerance.…”

Evolving spinal analgesia practice in palliative care

“…In contrast, pure, freeze-dried diamorphine is widely and easily available in UK medical practice. Most of the evidence for the use of intrathecal opioids in cancer pain refers to morphine 7,20,[36][37][38][39][40][41][42][43][44][45][46][47] To date there is little published evidence on the use of intrathecal diamorphine in this population, although it is used widely in anaesthetics and chronic pain in the UK. The pharmacokinetics of morphine and diamorphine in the intrathecal space are different.…”