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Continuous intrathecal morphine infusion in patients with vertebral fractures due to osteoporosis.
Clin J Pain. 2007 Jul-Aug; 23(6):511-7.CJ

Abstract

OBJECTIVES

Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QOL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side effects. Continuous intrathecal administration of morphine via an implantable pump might represent an alternative therapy to conventional oral or transdermal administration of opioids and has some advantages and disadvantages for pain relief and improvement in QOL when compared with conventional opioid delivery. It is our objective to report our experience using intrathecal delivery of analgesics in a population of patients with refractory pain due to vertebral fractures.

MATERIALS AND METHODS

In 24 patients, refractory to conventional delivery of opioids, we used intrathecal analgesic therapy. To test for efficacy and improvement in QOL, we administered the visual analog scale for pain and the Questionnaire of the European Foundation of Osteoporosis (QUALEFFO). Before patients were selected for pump implantation, an intraspinal drug delivery trial was performed to monitor side effects and responses to intrathecal therapy.

RESULTS

Significant pain relief was obtained in all implanted patients. Using the QUALEFFO, we observed significant improvement of all variables such as quality of daily life, domestic work, ambulation, and perception of health status, before and after 1 year after pump implantation. With intrathecal morphine infusion, none of the 24 patients required additional systemic analgesic medication. The mean morphine dose during the spinal trial was 11.28 mg/d, 7.92 mg/d at pump implantation, and 16.32 mg/d at 1-year follow-up.

CONCLUSIONS

Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QOL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side effects with systemic administration of analgesics.

Authors+Show Affiliations

Pain Unit and Palliative Care, S. Maria Misericordia Hospital, Rovigo, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17575491

Citation

Shaladi, Alì, et al. "Continuous Intrathecal Morphine Infusion in Patients With Vertebral Fractures Due to Osteoporosis." The Clinical Journal of Pain, vol. 23, no. 6, 2007, pp. 511-7.
Shaladi A, Saltari MR, Piva B, et al. Continuous intrathecal morphine infusion in patients with vertebral fractures due to osteoporosis. Clin J Pain. 2007;23(6):511-7.
Shaladi, A., Saltari, M. R., Piva, B., Crestani, F., Tartari, S., Pinato, P., Micheletto, G., & Dall'Ara, R. (2007). Continuous intrathecal morphine infusion in patients with vertebral fractures due to osteoporosis. The Clinical Journal of Pain, 23(6), 511-7.
Shaladi A, et al. Continuous Intrathecal Morphine Infusion in Patients With Vertebral Fractures Due to Osteoporosis. Clin J Pain. 2007 Jul-Aug;23(6):511-7. PubMed PMID: 17575491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous intrathecal morphine infusion in patients with vertebral fractures due to osteoporosis. AU - Shaladi,Alì, AU - Saltari,Maria Rita, AU - Piva,Bruno, AU - Crestani,Francesco, AU - Tartari,Stefano, AU - Pinato,Paolo, AU - Micheletto,Giuseppe, AU - Dall'Ara,Roberto, PY - 2007/6/19/pubmed PY - 2007/7/31/medline PY - 2007/6/19/entrez SP - 511 EP - 7 JF - The Clinical journal of pain JO - Clin J Pain VL - 23 IS - 6 N2 - OBJECTIVES: Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QOL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side effects. Continuous intrathecal administration of morphine via an implantable pump might represent an alternative therapy to conventional oral or transdermal administration of opioids and has some advantages and disadvantages for pain relief and improvement in QOL when compared with conventional opioid delivery. It is our objective to report our experience using intrathecal delivery of analgesics in a population of patients with refractory pain due to vertebral fractures. MATERIALS AND METHODS: In 24 patients, refractory to conventional delivery of opioids, we used intrathecal analgesic therapy. To test for efficacy and improvement in QOL, we administered the visual analog scale for pain and the Questionnaire of the European Foundation of Osteoporosis (QUALEFFO). Before patients were selected for pump implantation, an intraspinal drug delivery trial was performed to monitor side effects and responses to intrathecal therapy. RESULTS: Significant pain relief was obtained in all implanted patients. Using the QUALEFFO, we observed significant improvement of all variables such as quality of daily life, domestic work, ambulation, and perception of health status, before and after 1 year after pump implantation. With intrathecal morphine infusion, none of the 24 patients required additional systemic analgesic medication. The mean morphine dose during the spinal trial was 11.28 mg/d, 7.92 mg/d at pump implantation, and 16.32 mg/d at 1-year follow-up. CONCLUSIONS: Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QOL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side effects with systemic administration of analgesics. SN - 0749-8047 UR - https://www.unboundmedicine.com/medline/citation/17575491/Continuous_intrathecal_morphine_infusion_in_patients_with_vertebral_fractures_due_to_osteoporosis_ L2 - https://doi.org/10.1097/AJP.0b013e31806a23d4 DB - PRIME DP - Unbound Medicine ER -