Chronic
cancer pain remains intractable by standard treatment in many patients and interferes with their mobility and independence. Epidural
morphine infusion
therapy is adopted for providing adequate
analgesia in patients who are generally
morphine independent and have
intractable pain. A totally implantable pump system, Infusaid, has allowed continuous epidural
morphine infusion without
wound care or frequent percutaneous
injections and with a potentially lowered risk of adverse reactions including respiratory suppression. Since December 1984, the authors have used this totally implantable drug delivery system for continuous epidural
morphine infusion in two patients who had been suffering from
chronic pain caused by
pelvic cancer associated with metastatic and/or invasive lesions: Case 1: a 61-year-old man with
rectum cancer; and Case 2: a 44-year-old man with
colon cancer. Before system implantation, a therapeutic response to epidural
morphine was confirmed by a one-shot test injection.
Pain relief was evaluated by use of Visual
Pain Analogue Scale Scores (VPASS). In spite of the presence of an artificial anus on the left abdomen in both patients and of
pus discharge from a sacral infectious
fistula on admission in Case 2, no infectious complication occurred in either case.
Urinary retention developed after the implantation in Case 2, but this improved following the reduction of
morphine concentration. No other adverse reaction was observed. In Case 1, the system was effective for 6 months until his death from advancing
malignancy, and the patient was able to return to work three months after discharge.(ABSTRACT TRUNCATED AT 250 WORDS)