title: Combined epidural morphine and bupivacaine in the treatment of lumbosacral radicular neuropathic pain: a noncontrolled prospective study.
abstract: OBJECTIVE
  The aim of this study was to investigate the therapeutic effectiveness of epidural morphine and bupivacaine in patients with chronic lumbosacral radicular neuropathic pain after the cessation of treatment.
  
  
  METHODS
  Twenty-two patients with chronic lumbosacral pain with neuropathic features were enrolled. An indwelling catheter was placed into the epidural space, and each patient received an epidural injection of morphine chlorhydrate and bupivacaine up to three times a day. The medication was administered for 4 weeks. The pain intensity score on a 0-10 numeric rating scale (NRS), the total pain rating index rank (PRIr-T), and its coefficients were evaluated before treatment and 1 month after catheter removal.P-value <0.05 was considered statistically significant.
  
  
  RESULTS
  NRS and PRIr-T were significantly reduced at follow-up (P=0.001 andP=0.03, respectively), whereas the parallel evolution of the two scores (r=0.75 andP<0.001, respectively) confirmed significant pain relief lasting up to 1 month after treatment cessation. None of the four pain rating coefficients was significantly modified compared to the others in either responders or nonresponders. Successful clinical outcome (pain reduction >30% in NRS) was reached and maintained in half of the patients at follow-up.
  
  
  CONCLUSIONS
  Combined epidural morphine and bupivacaine seems to be effective in the treatment of neuropathic pain.
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo; Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vigneri
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sindaco
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: La Grua
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zanella
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ravaioli
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Paci
authors.affiliation: Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, RO, Italy.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Pari
keywords: bupivacaine; chronic pain; epidural; neuropathic pain; opioids