LONG-TERM INTRASPINAL INFUSIONS OF OPIOIDS IN THE TREATMENT OF NEUROPATHIC PAIN

被引:91
作者
HASSENBUSCH, SJ
STANTONHICKS, M
COVINGTON, EC
WALSH, JG
GUTHREY, DS
机构
[1] MD ANDERSON CANC CTR, DEPT ONCOL, HOUSTON, TX 77030 USA
[2] CLEVELAND CLIN FDN, CTR PAIN MANAGEMENT, DIV ANESTHESIOL, CLEVELAND, OH 44195 USA
[3] CLEVELAND CLIN FDN, DEPT NEUROSURG, CLEVELAND, OH 44195 USA
关键词
PAIN; NEUROPATHIC; OPIOID; MORPHINE; SUFENTANIL; INTRATHECAL; PUMP; COMPLICATIONS;
D O I
10.1016/0885-3924(95)00087-F
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Long-term intraspinal infusions of opioid drugs are being increasingly utilized in patients with noncancer pain. Despite this, there is a lack of long-ten information including success and failure rates for pain relief and technical problems. During a 5-year period, 18 noncancer patients underwent implantation of programmable infusion pumps for long-term intrathecal opioid infusion. Patients had (a) neuropathic pain, (b) had failed or been ineligible for noninvasive treatments, and (c) obtained greater than 50% pain relief with intrathecal trial infusions of morphine sulfate or sufentanil citrate. A disinterested third-party reviewer evaluated patients at the most recent follow-up. Sixty-one percent (11/18) of patients had good or fair pain relief with mean follow-up 2.4 +/- 0.3 years (0.8-4.7 years). Average numeric pain scores decreased by 39% +/- 4.3%. Five of the 11 responders required lower opioid doses (12-24 mg/day morphine) and the remaining six patients required higher opioid doses (>34 mg/day morphine). Failure of long-term pain relief occurred in 39% (7/18) despite good pain relief in trial infusions and the use of both morphine and sufentanil. Technical problems developed in 6/18 patients but appeared to be preventable with further experience Long-term intrathecal opioid infusions can be effective in treatment of neuropathic pain but might require higher infusion doses.
引用
收藏
页码:527 / 543
页数:17
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