LONG-TERM INTRATHECAL INFUSION OF MORPHINE IN THE HOME CARE OF PATIENTS WITH ADVANCED CANCER

Background: Fear of infections and other complications has made many c linicians avoid intrathecal application of morphine in chronic cancer pain. However, recent comparative studies show that, in long-term trea tment, intrathecal morphine administration may give a more satisfactor y pain relief with lower doses of morphine and fewer side-effects than epidural administration. In Montpellier Cancer Institute, first cance r pain patients received long-term intrathecal morphine as early as in 1979, and since then more than 400 patients have been treated. Method s: In 1991-1994, 50 patients having refractory cancer pain were treate d with a continuous intrathecal infusion of morphine using an external pump with patient-controlled boluses. In this retrospective study, th e outcome of these 5602 days of morphine therapy will be analysed. The treatment consisted of a lateral puncture technique, strictly aseptic conditions during catheter insertion and changes of pump reservoirs, and effective prevention of side-effects. Results: The average duratio n of intrathecal infusion was 142 (7-584) days. The mean starting dose , 2.5 (0.4-8.3) mg/day, increased to a mean final dose of 9.2 (1-94) m g/day, the average dose being 5.4 (1-23) mg/day. During the treatment period, no clinically detectable infections and no respiratory depress ion occurred. Leakage of cerebrospinal fluid followed by post-spinal h eadache occurred in only 6 patients who received a temporary external catheter: the lateral lumbar puncture technique seemed to protect from this complication in long-term treatment. The patients stayed at home , coming to agreed control visits only at 4-6-week intervals, using a telephone-telefax service for emergencies. Conclusions: Long-term intr athecal morphine infusion seems to provide satisfactory analgesia, few side-effects and a high degree of patient autonomy.