Shaladi Alì, Saltari Maria Rita, Piva Bruno, Crestani Francesco, Tartari Stefano, Pinato Paolo, Micheletto Giuseppe, Dall'Ara Roberto
Pain Unit and Palliative Care, S. Maria Misericordia Hospital, Rovigo, Italy.
Clin J Pain. 2007 Jul-Aug;23(6):511-7. doi: 10.1097/AJP.0b013e31806a23d4.
Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QOL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side effects. Continuous intrathecal administration of morphine via an implantable pump might represent an alternative therapy to conventional oral or transdermal administration of opioids and has some advantages and disadvantages for pain relief and improvement in QOL when compared with conventional opioid delivery. It is our objective to report our experience using intrathecal delivery of analgesics in a population of patients with refractory pain due to vertebral fractures.
In 24 patients, refractory to conventional delivery of opioids, we used intrathecal analgesic therapy. To test for efficacy and improvement in QOL, we administered the visual analog scale for pain and the Questionnaire of the European Foundation of Osteoporosis (QUALEFFO). Before patients were selected for pump implantation, an intraspinal drug delivery trial was performed to monitor side effects and responses to intrathecal therapy.
Significant pain relief was obtained in all implanted patients. Using the QUALEFFO, we observed significant improvement of all variables such as quality of daily life, domestic work, ambulation, and perception of health status, before and after 1 year after pump implantation. With intrathecal morphine infusion, none of the 24 patients required additional systemic analgesic medication. The mean morphine dose during the spinal trial was 11.28 mg/d, 7.92 mg/d at pump implantation, and 16.32 mg/d at 1-year follow-up.
Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QOL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side effects with systemic administration of analgesics.
椎体骨折是严重骨质疏松最常见的后果。骨质疏松性椎体塌陷引起的慢性疼痛会影响患者的生活质量（QOL）和自主性。口服或经皮使用阿片类药物治疗疼痛可能会引起严重的副作用。通过植入式泵持续鞘内注射吗啡可能是传统口服或经皮给予阿片类药物的替代疗法，与传统阿片类药物给药相比，在缓解疼痛和改善生活质量方面有一些优缺点。我们的目的是报告我们在因椎体骨折导致顽固性疼痛的患者群体中使用鞘内给药镇痛的经验。
在24例对传统阿片类药物给药无效的患者中，我们使用了鞘内镇痛疗法。为了测试疗效和生活质量的改善情况，我们使用了视觉模拟疼痛量表和欧洲骨质疏松基金会问卷（QUALEFFO）。在选择患者进行泵植入之前，进行了脊髓药物输送试验，以监测鞘内治疗的副作用和反应。
所有植入患者均获得了显著的疼痛缓解。使用QUALEFFO，我们观察到在泵植入前和植入后1年，所有变量如日常生活质量、家务劳动、行走能力和健康状况感知均有显著改善。鞘内注射吗啡后，24例患者均无需额外的全身镇痛药物。脊髓试验期间的平均吗啡剂量为11.28mg/d，泵植入时为7.92mg/d，1年随访时为16.32mg/d。
我们的结果表明，鞘内注射吗啡可有效缓解疼痛症状并改善生活质量。持续鞘内注射吗啡似乎是传统镇痛药物给药的替代疗法，对于全身使用镇痛药有严重副作用的患者具有优势。
