title: Intracerebroventricular morphine for refractory cancer pain: transitioning to the home setting.
abstract: Refractory cancer pain may be effectively controlled by titrating intracerebroventricular (ICV) preservative-free opioid. In this case report, a continuous infusion of ICV morphine permitted our patient with lung cancer and painful spinal metastases to be discharged to home hospice with family. The approach exploits the high potency of morphine injected into cerebrospinal fluid (CSF). Sterile, injectable, preservative-free morphine is directly infused into CSF through a subcutaneous Ommaya reservoir placed under the scalp by a neurosurgeon, with an attached catheter passed through a burr hole in the skull with its tip in a cerebral ventricle. Although investigators have described home care of patients receiving intraspinal analgesics, no report describes the process of transitioning the patient receiving continuous ICV morphine infusion to the home setting.
authors.affiliation: Medicine and Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, Columbus, Ohio 43210, USA. Michael.adolph@osumc.edu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Adolph
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stretanski
authors.forename: John M
authors.initials: JM
authors.lastname: McGregor
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Rawn
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Ross
authors.forename: Costantino
authors.initials: C
authors.lastname: Benedetti
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007276:Injections, Intraventricular; D008175:Lung Neoplasms / Q000150:complications; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010148:Intractable Pain / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine