title: Evaluation of continuous intraspinal narcotic analgesia for chronic pain from benign causes.
abstract: Intraspinal narcotic analgesia (INA) has been used for chronic pain from nonmalignant causes with moderate success. To ascertain the efficacy of the morphine pump, we reviewed the 2-year results of continuous INA in 18 patients with failed back syndrome or arachnoiditis and intractable, debilitating pain that was unrelieved by conventional means. All patients underwent a trial screening of single-dose intrathecal narcotics with good pain relief. After 2 years, 8 pumps were still functioning, 8 patients had the pump removed or turned off, and 2 patients were lost to follow-up. Our patients averaged 1.4 additional procedures or hospitalizations after initial pump insertion. Overall, only 4 patients had objective evidence of benefit from INA, for a success rate of 25%. Results of this review suggest INA should not be used for the long-term management of chronic pain from nonmalignant causes.
authors.affiliation: Complex Spine Clinic, Rancho Los Amigos Medical Center, Downey, California, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Yoshida
authors.forename: R W
authors.initials: RW
authors.lastname: Nelson
authors.forename: D A
authors.initials: DA
authors.lastname: Capen
authors.forename: S
authors.initials: S
authors.lastname: Nagelberg
authors.forename: J C
authors.initials: JC
authors.lastname: Thomas
authors.forename: R L
authors.initials: RL
authors.lastname: Rimoldi
authors.forename: W
authors.initials: W
authors.lastname: Haye
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001100:Arachnoiditis / Q000150:complications*; D001416:Back Pain / Q000188:drug therapy* / Q000601:surgery; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid