植入性鞘内药物(吗啡)输注系统治疗顽固性疼痛的临床观察

目的:探讨植入性蛛网膜下腔(即鞘内)药物(吗啡)输注系统(implantedintrathecaldrugdeliverysystem,IDDS)在顽固性疼痛治疗中的临床意义。方法:对4例因顽固性疼痛(癌痛和非癌痛)、药物治疗无法缓解而实施植入性鞘内药物输注系统的病人进行临床效果评价。结果:筛选试验成功后,经过外科手术将IDDS植入体内,术后给予持续输注吗啡,经过剂量调整,镇痛效果较明显,副作用减轻。结论:通过IDDS将镇痛药物(吗啡)直接注入作用部位(脊髓和大脑),镇痛效果确切,同时避免了全身给药时的副反应,是针对顽固性疼痛(癌痛和非癌痛)的三阶梯治疗以外的一种有效方法。应用时应掌握适应症,并进行筛选试验确定治疗的有效性,并根据疼痛缓解程度和副作用进行剂量调整。

Clinical evaluation of implanted intrathecal drug (morphine) delivery system in treatment of patients with intractable pain

AIM: To evaluate the effectiveness and safety profile of implanted intrathecal drug (morphine) delivery system in treatment of patients with intractable pain. METHODS: 4 patients suffering from intractable pain were treated with intrathecal morphine using implanted drug delivery system for pain control. The clinical data were recorded and analyzed retrospectively. RESULTS: These patients included 2 cases of cancer pain, 2 cases of benign back pain after back operation (Failed Back Syndrome). All of them had tried big doses of oral or intravenous strong opioid, with poor pain relief and intolerable side effects. Before the implantation, all patients had trial test, i.e, certain amount of morphine (referring to the daily systemic dosage) were injected into intrathecal or epidural space to test whether the pain relief would be satisfactory without severe side effects. The VAS scale decreased up to 50% or more after the intrathecal morphine, suggesting the positive result of trial test. They were then operated and the intrathecal drug delivery systems were implanted. After the operation, the intrathecal morphine dosage was adjusted according to the pain VAS scale as well as the side effect profile. All the patients showed significant pain relief without serious side effect. CONCLUSION: The implanted intrathecal drug delivery system infusing analgesics directly into the target area (spinal cord and brain) proves to be effective for intractable pain control and have fewer side effects. As an invasive and expensive technique, its application should be cautious and trial tests should be done before the implantation.