[Our experience in the chemical spinal neuromodulation in chronic pain from spinal collapse due to osteoporosis.].
OBJECTIVE
Osteoporosis is a metabolic disease of the bone characterized by reduced bone mass and microstructural deterioration of bone tissue with a consequent increase in bone fragility and risk of vertebral collapse. Treatment of osteoporosis with the new molecule is effective in improving the density and quality of bone but does not provide an analgesic effect for patients with vertebral collapse. The treatment of chronic pain from vertebral collapse is difficult and may require the use of opioids, but for some patients the intake of these drugs is burdened with systemic side effects. The aim of our study is to use the way in reducing intrathecal opioid dosage and at the same time have good pain control without significant side-effects. We report our experience in the use of continuous infusion pump for intrathecal morphine in patients with chronic pain from osteoporotic vertebral collapse that can not tolerate therapy with systemic opioids because of severe side effects.


METHODS
24 patients (19 women and 5 men with average age of 73.3 years) with a diagnosis of chronic pain from vertebral collapse refractory to treatment for systemic analgesic were treated with the use of pumps for intrathecal infusion of morphine. All patients were fit the criteria for inclusion. For the measurement of pain the visual analogue scale (VAS) in three stages: T0, T1, T2 was administered to all patients. For the evaluation of the quality of life the Questionnaire of quality of life of the European Foundation for Osteoporosis (QUALEFFO) was administered in three times.


RESULTS
In the one year follow-up there was a significant reduction in pain measured by VAS, from 8.5 to 1.9 in T0 to T2 in all patients. Similarly there was a reduction in the average score of QUALEFFO of all variables, from T0 equal to 114.7 to T2 equal to 79.1. With the intrathecal infusion of morphine no patient required an additional systemic treatment.


CONCLUSIONS
This study demonstrates that intrathecal-morphine therapy offers patients relief from pain and a good quality of life. Continuous intrathecal infusion of morphine is a valuable therapy and is particularly suitable for those patients who show side effects with the administration of systemic opioids.
Shaladi
A M
AM
Servizio Terapia del Dolore e Cure Palliative, Azienda ULSS 18 Rovigo, Italia.
Crestani
F
F
Tartari
S
S
Piva
B
B
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001416:Back Pain / Q000188:drug therapy* / Q000209:etiology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D017148:Infusions, Intraosseous; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D013122:Spinal Diseases / Q000150:complications* / Q000209:etiology*
D000701:Analgesics, Opioid