Intraspinal delivery of opiates by an implantable, programmable pump in patients with chronic, intractable pain of nonmalignant origin.

The use of intraspinal therapy for the management of intractable pain from nonmalignant causes has not been widely discussed. An implantable, externally programmable infusion pump was used for intraspinal delivery of morphine sulfate to 15 patients with intractable pain from reflex sympathetic dystrophy, arachnoiditis after spinal surgery, or an unknown cause. Dosage patterns were individualized. At follow-up ranging from 2 to 44 months, pain relief was reported as excellent by 8 patients, good by 3, and fair by 4. Six patients have returned to work. Two patients chose to terminate therapy. Few complications occurred, but most patients needed increasingly larger doses over time to maintain pain relief. Intraspinal infusion of morphine sulfate by use of an implanted, externally programmable pump is safe and effective in selected patients with intractable pain of nonmalignant origin.