Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer

BACKGROUND Pain secondary to unresectable pancreatic cancer is frequently s evere and extremely difficult to control with traditional methods of analge sia. This retrospective study reports the analgesic effects of intrathecal morphine sulfate by implanted infusion pumps in nine patients with unresect able adenocarcinoma of the pancreas. METHODS Nine patients were implanted over a P-year period, Preoperative mor phine IV equivalents were a mean of 81.51 mg/day, with a range of 20-140 mg /day, Patients were hospitalized for a trial dose of 1-2 mg of intrathecal Duramorph, 1 mg/ml, via lumbar puncture to assess whether adequate pain rel ief could be achieved and whether there would be drug-related side effects, RESULTS All patients who received a trial dose experienced excellent pain r elief, and subsequently underwent implantation of a lumbar subarachnoid cat heter and infusion pump during the same hospitalization. The mean number of days from diagnosis to pump implant was 119, with a range of 3-587 days. T he mean maximum daily dose was 21.28 mg, with a range of 3-73.10 mg, No pat ient experienced respiratory depression or excess sedation which prevented achievement of pain control. Minor supplemental narcotic use was documented in three of the nine patients. Assessment of pain control was made by the level of activity and the analog pain scale, with 0 being no pain and 10 be ing the worst pain imaginable, All of the patients experienced good to exce llent relief of pain. The mean duration of intrathecal morphine sulfate use until death was 137.3 days, with a range of 52-354 days. CONCLUSIONS This series of nine patients indicates that long-term administr ation of intrathecal morphine via implanted infusion pump in patients with pancreatic cancer is both efficacious and safe, All patients and their fami lies reported an improved quality of life with an increased level of activi ty. (C) 1999 by Elsevier Science Inc.