The Management of Pain From Collapse of Osteoporotic Vertebrae With Continuous Intrathecal Morphine Infusion

Polyanalgesic Consensus Conference—2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain

“…Chemical‐ or drug‐induced aseptic meningitis can also result from hypersensitivity to medications or interaction of the drug or drug metabolites with serum antibodies (50). The incidence of meningitis or other infections (Table 3) in patients receiving IT therapy was documented in nine published reports that comprised four retrospective studies (38,45,48,51), four prospective studies (37,39,52,53), and one case series report (40).…”

“…Catheter infections, implant site wound infections, or both were documented in five studies (37,38,40,51,53). In a retrospective cohort study of 29 patients who received combination therapy with morphine and nonopioid analgesics via implanted pumps for the treatment of cancer pain (51), a catheter‐related infection was reported in one patient at six months after implantation; the infection necessitated removal of the catheter.…”

“…In a retrospective study of IT therapy with morphine or other opioid medications, wound infections prompted removal of the implanted IT device in 5 of 57 patients (38). Wound infections were also noted in two prospective studies of IT morphine monotherapy in patients with implanted infusion devices (37,53). In one study, infection or cellulitis occurred in 6 of 110 patients; surgical removal of the device was required in four patients with implant site infections (37).…”

“…In one study, infection or cellulitis occurred in 6 of 110 patients; surgical removal of the device was required in four patients with implant site infections (37). In the other study, among 24 patients receiving IT morphine monotherapy for pain related to osteoporosis, one patient developed a wound infection that required antibiotic treatment (53). Thus the rate of infection, although low, is an obvious area for improvement in clinical outcomes of IDSS therapy.…”

Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

“…The intention‐to‐treat analysis revealed an overall success rate of IT opioid therapy of 76.9% of patients. In another open‐label study, IT morphine was infused in 24 patients with vertebral fractures due to osteoporosis who had not responded to systemic opioid therapy (88,89). The mean VAS pain score decreased significantly from 8.7 cm before IT therapy to 1.9 cm after one year of IT therapy ( p < 0.001).…”