Angel I F, Gould H J, Carey M E
Department of Neurosurgery, Louisiana State University Medical Center, New Orleans 70112, USA.
Surg Neurol. 1998 Jan;49(1):92-8; discussion 98-9. doi: 10.1016/s0090-3019(97)00287-5.
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. Options for treating chronic pain of non-malignant origin are more controversial. This study describes responses to intrathecal morphine administration for managing chronic pain in patients without an underlying malignancy.
Eleven patients between the ages of 29 and 81 years, nine with failed back syndrome (FBS) and two with neuropathic pain (NP) from other causes, were chosen from 15 consecutive individuals referred to neurosurgery clinic. The presenting levels of pain and a functional-economic outcome level were determined for each patient. Patients were admitted to the hospital for therapeutic trials and were assessed for the appropriateness of their analgesic response and for adverse responses to the medication. A morphine pump was implanted in five males and six females who were followed for up to 3 years.
A good to excellent analgesic response was seen in 8 (73%) patients (6 FBS; 2 NP). In the remaining three patients (27%), the analgesic response was judged poor (3 FBS). In patients with FBS, the total effective response was 67%. Two patients experienced bladder dysfunction requiring pump removal. Other adverse effects of pump placement were rare.
The morphine pump was found to be a viable alternative in the management of failed back syndrome. Its use in long-term therapy, however, is not without limitations and should be a last choice option.
用于鞘内注射吗啡的植入式泵已成为晚期癌症患者使用阿片类药物治疗疼痛的常用选择。对于治疗非恶性起源的慢性疼痛，选择更具争议性。本研究描述了鞘内注射吗啡治疗无潜在恶性肿瘤患者慢性疼痛的反应。
从连续转诊至神经外科诊所的15名患者中选取了11名年龄在29至81岁之间的患者，其中9名患有失败腰综合征（FBS），2名因其他原因患有神经性疼痛（NP）。确定了每位患者的疼痛初始水平和功能 - 经济结果水平。患者入院进行治疗试验，并评估其镇痛反应的适宜性和对药物的不良反应。为5名男性和6名女性植入了吗啡泵，并对他们进行了长达3年的随访。
8名（73%）患者（6名FBS；2名NP）出现了良好至优秀的镇痛反应。其余3名患者（27%）的镇痛反应被判定为较差（3名FBS）。在患有FBS的患者中，总有效反应率为67%。两名患者出现膀胱功能障碍，需要移除泵。泵植入的其他不良反应很少见。
吗啡泵被发现是治疗失败腰综合征的一种可行替代方法。然而，其在长期治疗中的应用并非没有局限性，应作为最后选择的方案。
