BACKGROUND Implantable pumps for the delivery of intrathecal morphine
have become a common option for administering opiate medication for th
e management of pain in patients with terminal cancer. Options for tre
ating chronic pain of non-malignant origin are more controversial. Thi
s study describes responses to intrathecal morphine administration for
managing chronic pain in patients without an underlying malignancy. M
ETHODS Eleven patients between the ages of 29 and 81 years, nine with
failed back syndrome (FBS) and two with neuropathic pain (NP) from oth
er causes, were chosen from 15 consecutive individuals referred to neu
rosurgery clinic. The presenting levels of pain and a functional-econo
mic outcome level were determined for each patient. Patients were admi
tted to the hospital for therapeutic trials and were assessed for the
appropriateness of their analgesic response and for adverse responses
to the medication. A morphine pump was implanted in five males and six
females who were followed for up to 3 years. RESULTS A good to excell
ent analgesic response was seen in 8 (73%) patients (6 FBS; 2 NP). In
the remaining three patients (27%), the analgesic response was judged
poor (3 EBS). In patients with FBS, the total effective response was 6
7%. Two patients experienced bladder dysfunction requiring pump remova
l. Other adverse effects of pump placement were rare. CONCLUSIONS The
morphine pump was found to be a viable alternative in the management o
f failed back syndrome. Its use in long-term therapy, however, is not
without limitations and should be a last choice option. (C) 1998 by El
sevier Science Inc.