Intrathecal opioid pump

Implantable pumps for the delivery of intrathecal morphine have become a common option for administering opiate medication for the management of pain in patients with terminal cancer.

Intrathecal (IT) opiod pumps are one therapeutic cornerstone of refractory non malignant pain syndromes. The aim of a study of Sommer et al., was to evaluate efficacy, surgical and pharmacological complications of intrathecal pumps beyond a time span of 10 years.

In this retrospective single-center cohort study, 27 patients (14 female, 13 male, age 64.0 ± 8.9 (median, 1 SD) yrs) were identified. Pain intensity using the numerical rating scale (NRS), pain and IT pump characteristics, and complications were analyzed. The German Pain Questionaire was used to investigate the physical and mental health status.

Overall time of IT therapy from first implantation to last follow-up was 20.4 ± 6.0 yrs. Time to implantation of the second pump (n=18) was 10.0 ± 5.3 yrs, between the second and third pump (n=6) 6.5 ± 2.7 yrs, and two patients received their 4th pump six years later. Before implantation, NRS was 9.0 ± 0.9, one year after implantation 7.0 ± 1.8 and 4.0 ± 2.3 at the last follow-up. IT drug dose remained stable after 3 years. Opioid intoxications occurred in three patients (10%). One patient (3%) underwent revision surgery due to a catheter infection. Drug side effects occurred in 4 patients (14%). Our patient group has pain-related restrictions in physical activities with menial impact regarding mental and emotional stress.

Even after a time span of over 15 years and several exchanges of pump systems, pain intensity is still reduced. After 3 years, IT drug dose remained unchanged with low side-effects and complication rates ¹⁾.