Implantable continuous epidural morphine infusion system for relief of chronic cancer pain
Moritake, K.; Handa, H.; Umeda, S.; Nishioka, T.; Suwa, H.; Konishi, T.; Takaya, M.
No Shinkei Geka. Neurological Surgery 14(6): 761-768
1986
ISSN/ISBN: 0301-2603 PMID: 3748284 Document Number: 285734
Chronic cancer pain remains intractable by standard treatment in many patients and interferes with their mobility and independence. Epidural morphine infusion therapy is adopted for providing adequate analgesia in patients who are generally morphine independent and have intractable pain. A totally implantable pump system, Infusaid, has allowed continuous epidural morphine infusion without wound care or frequent percutaneous injections and with a potentially lowered risk of adverse reactions including respiratory supression. Since December 1984, the authors have used this totally implantable drug delivery system for continuous epidural morphine infusion in two patients who had been suffering from chronic pain caused by pelvic cancer associated with metastatic and/or invasive lesions: Case 1: a 61-year-old man with rectum cancer; and Case 2: a 44-year-old man with colon cancer. Before system implantation, a therapeutic response to epidural morphine was confirmed by a one-shot test injection. Pain relief was evaluated by use of Visual Pain Analogue Scale Scores (VPASS). In spite of the presence of an artificial anus on the left abdomen in both patients and of pus discharge from a sacral infectious fistula on admission in Case 2, no infectious complication occurred in either case. Urinary retention developed after the implantation in Case 2, but this improved following the reduction of morphine concentration. No other adverse reaction was observed. In Case 1, the system was effective for 6 months until his death from advancing malignancy, and the patient was able to return to work three months after discharge. In Case 2, the pain is well cntrolled and the patient is now living at home with his family and preparing to return to his job.