Intrathecal Morphine Delivery at Cisterna Magna to Control Refractory Cancer-Related Pain: A Prospective Cohort Study.

Abstract

Background:

For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.

Methods:

Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.

Results:

Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).

Conclusions:

Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.

• Authors: Chang Sun, Yu-Tong Wang, Yu-Jie Dai, Zhi-Hui Liu, Jing Yang, Zhu-Qiang Cheng, Dao-Song Dong, Cheng-Fu Wang, Guo-Li Zhao, Gui-Jun Lu, Tao Song, Yi Jin, Li-Li Sun, Alan D Kaye, Ivan Urits, Omar Viswanath, Yong-Hai Sun
• Journal: Psychopharmacology bulletin (Psychopharmacol Bull) Vol. 50 Issue 4 Suppl 1 Pg. 48-66 (10 15 2020) ISSN: 2472-2448 [Electronic] United States
• PMID: 33633417 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.

Chemical References

• Morphine

Topics

• Cancer Pain (drug therapy)
• Cisterna Magna
• Humans
• Injections, Spinal
• Morphine (therapeutic use)
• Neoplasms (complications, drug therapy)
• Pain, Intractable (drug therapy, etiology)
• Prospective Studies
• Quality of Life