Continuous intracerebroventricular morphine infusion for intractable neuropathic pain.

OBJECTIVE: This study aimed to explore the effectiveness and safety of continuous intracerebroventricular (ICV) morphine infusion for intractable pathological pain in the head, face, and upper limbs using the SynchroMed II intrathecal drug infusion system. METHODS: The clinical data of eight patients with intractable pathological pain in the head, face, and upper limbs who were treated with ICV morphine infused using the SynchroMed II system were analyzed. The numeric rating scale (NRS) was used to evaluate the degree of pain. NRS change, morphine dose, and its side effects and complications were the main observation indicators. RESULTS: The average pain amelioration was 60.68% ± 15.40%. Furthermore, the Pre-op NRS was 9.000 ± 1.309; the Optimum NRS (Op-NRS)was 2.000 ± 1.414; and the last NRS(L-NRS)was 3.500 ± 1.414. The Preoperative NRS (Pre-op NRS)was significantly higher than the Op-NRS (t = 7.329, P<0.0001) and L-NRS (t = 8.072, P < 0.0001), whereas the Op-NRS and L-NRS showed no significant difference (t = 2.121, P = 0.0522). The mean initial dose was 212.5 ± 35.36 (range, 200–300) mcg/24 h; individual optimal dose, 445.0 ± 93.04 (range, 350–650) mcg/24 h; and final dose, 560.0 ± 256.0 (range, 350–1100) mcg/24 h. The side effects included nausea and vomiting, dizziness, and visual hallucinations. Transient urinary retention is a common side effect of drug dosage adjustment. All the patients without infection and cerebral hemorrhage and other complications. CONCLUSION: ICV morphine infusion using the SynchroMed II system is safe and effective for intractable pathological pain in the head, face, and upper limbs.