Andersen P E, Cohen J I, Everts E C, Bedder M D, Burchiel K J
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland.
Arch Otolaryngol Head Neck Surg. 1991 Nov;117(11):1277-80. doi: 10.1001/archotol.1991.01870230093015.
We describe our experience with nine patients with head and neck pain of malignant origin who were treated with continuous low-dose intrathecal morphine via a lumbar catheter and implantable subcutaneous drug delivery pump. All patients had failed prior attempts at oral narcotic pain control due to either poor pain control or intolerable side effects. Using a visual analogue scale where the most severe pain is rated as 10 and no pain is rated as 0, the mean visual analogue scale was reduced from 7.6/10 (range, 5 to 10/10) before implantation to 1.9/10, 2.0/10, and 0.5/10 at 1 week, 1 month, and 2 months after implantation, respectively. Complications were acceptable. We conclude that intrathecal administration of morphine is a safe and effective means of pain control. This method deserves serious consideration in patients with intractable pain secondary to head and neck malignancy.
我们描述了9例恶性肿瘤引起的头颈部疼痛患者的治疗经验，这些患者通过腰椎导管和植入式皮下给药泵接受持续低剂量鞘内吗啡治疗。所有患者此前口服麻醉性镇痛药控制疼痛均失败，原因是疼痛控制不佳或出现无法耐受的副作用。使用视觉模拟评分法（其中最严重疼痛评分为10分，无疼痛评分为0分），平均视觉模拟评分从植入前的7.6/10（范围为5至10/10）分别降至植入后1周、1个月和2个月时的1.9/10、2.0/10和0.5/10。并发症可以接受。我们得出结论，鞘内注射吗啡是一种安全有效的疼痛控制方法。对于头颈部恶性肿瘤继发的顽固性疼痛患者，这种方法值得认真考虑。
