title: The conversion challenge: from intrathecal to oral morphine.
abstract: Numerous articles have described the methodologies used and outcomes achieved with the intrathecal (IT) administration of morphine for pain. However, only one case report has been published that describes converting a patient's IT morphine to an oral regimen. This case report describes the experience of converting a patient's IT morphine to oral morphine and discusses the scarcity of published data to validate suggested equianalgesic intraspinal morphine recommendations. The calculated equianalgesic oral to IT ratio in this case was 12:1. This is substantially lower than the 300:1 ratio published by Krames and the 90:1 ratio employed by a commercially available software program for calculating equianalgesic opioid doses. We recommend caution when applying existing guidelines for conversion of morphine from an IT to an oral regimen.
authors.affiliation: MeritCare Hospital, Fargo, North Dakota, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Sylvester
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Lindsay
authors.forename: Caroline
authors.initials: C
authors.lastname: Schauer
mesh_terms: D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D013810:Therapeutic Equivalency
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine