title: Long-term intrathecal infusion of morphine in the home care of patients with advanced cancer.
abstract: BACKGROUND
  Fear of infections and other complications has made many clinicians avoid intrathecal application of morphine in chronic cancer pain. However, recent comparative studies show that, in long-term treatment, intrathecal morphine administration may give a more satisfactory pain relief with lower doses of morphine and fewer side-effects than epidural administration. In Montpellier Cancer Institute, first cancer pain patients received long-term intrathecal morphine as early as in 1979, and since then more than 400 patients have been treated.
  
  
  METHODS
  In 1991-1994, 50 patients having refractory cancer pain were treated with a continuous intrathecal infusion of morphine using an external pump with patient-controlled boluses. In this retrospective study, the outcome of these 5602 days of morphine therapy will be analysed. The treatment consisted of a lateral puncture technique, strictly aseptic conditions during catheter insertion and changes of pump reservoirs, and effective prevention of side-effects.
  
  
  RESULTS
  The average duration of intrathecal infusion was 142 (7-584) days. The mean starting dose, 2.5 (0.4-8.3) mg/day, increased to a mean final dose of 9.2 (1-94) mg/day, the average dose being 5.4 (1-23) mg/day. During the treatment period, no clinically detectable infections and no respiratory depression occurred. Leakage of cerebrospinal fluid followed by post-spinal headache occurred in only 6 patients who received a temporary external catheter: the lateral lumbar puncture technique seemed to protect from this complication in long-term treatment. The patients stayed at home, coming to agreed control visits only at 4-6 week intervals, using a telephone-telefax service for emergencies.
  
  
  CONCLUSIONS
  Long-term intrathecal morphine infusion seems to provide satisfactory analgesia, few side-effects and a high degree of patient autonomy.
authors.affiliation: Montpellier Cancer Institute Val d'Aurelle, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Gestin
authors.forename: A
authors.initials: A
authors.lastname: Vainio
authors.forename: A M
authors.initials: AM
authors.lastname: Pégurier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D005260:Female; D018718:Home Infusion Therapy; D006801:Humans; D007260:Infusion Pumps; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009369:Neoplasms / Q000150:complications*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine