title: Continuous intrathecal morphine infusion in patients with vertebral fractures due to osteoporosis.
abstract: OBJECTIVE
  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.
  
  
  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.affiliation: Pain Unit and Palliative Care, S. Maria Misericordia Hospital, Rovigo, Italy.
authors.forename: Alì
authors.initials: A
authors.lastname: Shaladi
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Saltari
authors.forename: Bruno
authors.initials: B
authors.lastname: Piva
authors.forename: Francesco
authors.initials: F
authors.lastname: Crestani
authors.forename: Stefano
authors.initials: S
authors.lastname: Tartari
authors.forename: Paolo
authors.initials: P
authors.lastname: Pinato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Micheletto
authors.forename: Roberto
authors.initials: R
authors.lastname: Dall'Ara
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010024:Osteoporosis / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D011788:Quality of Life; D016103:Spinal Fractures / Q000150:complications* / Q000209:etiology* / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl