Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology

Matthias Winkelmüller Department of Neurosurgery, Städtisches Klinikum Braunschweig, Braunschweig, Germany; and Department of Neurosurgery, Friederikenstift, Hannover, Germany

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Wolfhard Winkelmüller Department of Neurosurgery, Städtisches Klinikum Braunschweig, Braunschweig, Germany; and Department of Neurosurgery, Friederikenstift, Hannover, Germany

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✓ In the present retrospective investigation, the long-term effects of continuous intrathecal opioid therapy via implantable infusion pump systems were examined in 120 patients with chronic, nonmalignant pain syndromes. The follow-up period was 6 months to 5.7 years (mean 3.4 years ± 1.3 standard error of the mean). Deafferentation pain and neuropathic pain showed the best long-term results, with 68% and 62% pain reduction (visual analog scale), respectively. The mean morphine dosage initially administered was 2.7 mg/day (range 0.3–12 mg/day); after an average of 3.4 years, it was 4.7 mg/day (range 0.3–12 mg/day). In a long-term observation of 28 patients who received intrathecal morphine for longer than 4 years, 18 patients (64.3%) had a constant dosage history and 10 patients (35.7%) showed an increase in morphine dosage to more than ± mg/day 1 year after dosage determination. In seven cases, a tolerance developed; in four patients the tolerance was controlled by means of “drug holidays”; but in three patients it was necessary to remove the pump systems. Explantation of the pump system occurred in 22 additional cases for other reasons. Throughout the follow-up period, 74.2% of the patients profited from the intrathecal opiate therapy; the average pain reduction after 6 months was 67.4% and, as of the last follow-up examination, it was 58.1%. Ninety-two percent of the patients were satisfied with the therapy and 81% reported an improvement in their quality of life. The authors' 6-year experience with administration of intrathecal opioid medications for nonmalignant pain should encourage the use of this method in carefully selected patients.

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