Clinical realities and economic considerations: efficacy of intrathecal pain therapy.

Studies of analgesia in cancer patients have revealed that intrathecal administration of opioids can deliver potent analgesia with fewer systemic side effects than equivalent doses of systemic opioids. In addition, several trials have examined the safety and efficacy of this modality in patients with pain of nonmalignant origin. In one survey of 35 physicians involving 429 patients treated with intrathecal therapy, physician reports of global pain relief scores were excellent in 52.4% of patients, good in 42.9%, and poor in 4.8%. In another study of 120 patients, the mean pain intensity score had fallen from 93.6 to 30.5 six months after initiation of therapy. In both studies, patients reported significant improvement in activities of daily living, quality of life measures, and satisfaction with the therapy. Constipation, urinary retention, nausea, vomiting, and pruritus are typical early adverse effects of intrathecal morphine and are readily managed symptomatically. Other potential adverse effects include amenorrhea, loss of libido, edema, respiratory depression, and technical issues with the intrathecal system.

Invasive modalities for the diagnosis and treatment of pain in the elderly.

Modern pain management mandates that patients receive precise diagnoses of the etiology of their pain and then achieve the best possible pain relief using the most appropriate method of administration. Elderly patients are quite prone to the side effects of systemic medication used to treat pain, and it is fortunate that there exist today so many efficacious alternatives from which to choose. With more precise diagnosis and treatment of pain syndromes in the elderly, patients can achieve a higher level of function. It is therefore incumbent upon all physicians to ensure that their patients achieve adequate pain relief without untoward side effects by using the most appropriate amount of medication delivered by the most effective method.

Loin pain hematuria syndrome: pain relief with intrathecal morphine.

Loin pain hematuria syndrome (LPHS) is characterized by hematuria and incapacitating loin pain. The pain experienced with LPHS is, in general, extremely difficult to treat. Many surgical and pharmacologic therapies have been directed at LPHS pain without success. This report documents successful pain control in a patient with LPHS using long-term intrathecal morphine delivered via an implantable pump. Intrathecal narcotic therapy may provide pain relief for the chronic pain of LPHS.