The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Continuous Intrathecal Morphine Administration for Cancer Pain Management Using an Intrathecal Catheter Connected to a Subcutaneous Injection Port: A Retrospective Analysis of 22 Terminal Cancer Patients in Korean Population

  • Kim, Jong Hae (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Jung, Jin Yong (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Cho, Min Soo (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu)
  • Received : 2012.08.20
  • Accepted : 2012.10.31
  • Published : 2013.01.01
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Abstract

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the $1^{st}$, $3^{rd}$, $7^{th}$ and $30^{th}$ postoperative days were determined from medical records. Results: Intrathecal morphine administration for $46.0{\pm}61.3$ days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the $7^{th}$ and $30^{th}$ postoperative days compared to the $1^{st}$ postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

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References

  1. Holmfred A, Vikerfors T, Berggren L, Gupta A. Intrathecal catheters with subcutaneous port systems in patients with severe cancer-related pain managed out of hospital: the risk of infection. J Pain Symptom Manage 2006; 31: 568-72. https://doi.org/10.1016/j.jpainsymman.2005.11.010
  2. Vissers KC, Besse K, Wagemans M, Zuurmond W, Giezeman MJ, Lataster A, et al. 23. Pain in patients with cancer. Pain Pract 2011; 11: 453-75. https://doi.org/10.1111/j.1533-2500.2011.00473.x
  3. Smith TJ, Staats PS, Deer T, Stearns LJ, Rauck RL, Boortz- Marx RL, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 2002; 20: 4040-9. https://doi.org/10.1200/JCO.2002.02.118
  4. Deer TR, Smith HS, Burton AW, Pope JE, Doleys DM, Levy RM, et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician 2011; 14: E283-312.
  5. Hong SH, Lee GW. Upper body cancer pain management by cervical intrathecal catheterization: a case report. Korean J Anesthesiol 2008; 55: 135-8. https://doi.org/10.4097/kjae.2008.55.1.135
  6. Seo KC, Chung JY, Kim HY, Rho WS, Kim BI, Song SY. Intrathecal catheter and subcutaneous access port implantation in pain management for terminal cancer patient: a case report. Korean J Pain 2007; 20: 240-5. https://doi.org/10.3344/kjp.2007.20.2.240
  7. Mercadante S, Caraceni A. Conversion ratios for opioid switching in the treatment of cancer pain: a systematic review. Palliat Med 2011; 25: 504-15. https://doi.org/10.1177/0269216311406577
  8. Rauck RL, Cherry D, Boyer MF, Kosek P, Dunn J, Alo K. Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. J Pain 2003; 4: 441-7. https://doi.org/10.1067/S1526-5900(03)00730-2
  9. Becker R, Jakob D, Uhle EI, Riegel T, Bertalanffy H. The significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions. Stereotact Funct Neurosurg 2000; 75: 16-26. https://doi.org/10.1159/000048379
  10. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology 2006; 104: 570-87. https://doi.org/10.1097/00000542-200603000-00025
  11. Krames ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 1993; 8: 36-46. https://doi.org/10.1016/0885-3924(93)90118-F
  12. Belverud S, Mogilner A, Schulder M. Intrathecal pumps. Neurotherapeutics 2008; 5: 114-22. https://doi.org/10.1016/j.nurt.2007.10.070
  13. Aldrete JA. Intrathecal opioid infusions. Anesthesiology 2004; 101: 256; author reply 257-8. https://doi.org/10.1097/00000542-200407000-00043
  14. Anderson VC, Burchiel KJ. A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain. Neurosurgery 1999; 44: 289-300; discussion 300-1. https://doi.org/10.1097/00006123-199902000-00026
  15. Bailey PL, Rhondeau S, Schafer PG, Lu JK, Timmins BS, Foster W, et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology 1993; 79: 49-59; discussion 25A. https://doi.org/10.1097/00000542-199307000-00010
  16. Winkelmüller M, Winkelmüller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg 1996; 85: 458-67. https://doi.org/10.3171/jns.1996.85.3.0458
  17. Kroin JS, Ali A, York M, Penn RD. The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery 1993; 33: 226-30; discussion https://doi.org/10.1227/00006123-199308000-00007

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