Brain Disorders & Therapy

Intrathecal chronic morphine infusion pumps for intractable cancer pain: A pilot series in Russia

International Conference on Neuro Oncology and Rehabilitation

July 21-22, 2016 Brisbane, Australia

Dongwoo John Chang

CIGNA Hospital, USA

Scientific Tracks Abstracts: Brain Disord Ther

Abstract:

Chronic Pain Syndrome (CPS) is currently seen as an independent disease requiring etiopathogenetic treatment. Optimal way for cancer patients is opioid therapy. By reason of permanent presence of symptoms, the method of choice are implantable close sterile systems that do not require regular invasive procedures with minimal side opioid effects, that allow to stop strong pain, including �??breakthrough pain�?�. Thus the functional neurosurgery takes the increasing place in oncology. First experience in Russia applying programmable morphine infusion pumps for severe cancer pain belonged to P. Herzen Moscow Oncology Research Institute. The most significant indications for pump implantation were: The presence of heavy cancer pain (VAS>60), inefficiency of previous narcotic analgesics at doses equivalent to 30 mg morphine, life expectancy more than 3 months, and positive morphine test. Morphine pump installed 62 patients in 2013-2015. All patients diagnosed with CPS intensity of 60-100% by VAS (average 91.6±6.9), 28 patients had severe neuropatic pain. Side effects of opioid therapy were present in all patients. Implantation and pump programming was carried out according to the accepted method. The intensity of pain in all patients decreased to 0-20% by VAS (p-value=0.000301). Morphine dose vary from 180 to 9500 mg/day. All treated patients completely stopped taking opioids. We registered increase of motion activity in 51 cases, absence of sedation effects, improved somatic status. However, 26 patients with a long history of receiving opioid (over six months) from the second day developed specific withdrawal symptoms caused by the termination of systemic effects of opiates, requiring symptomatic therapy for 4-10 days. All patients reported more effective pain relief, lack of systemic side effects and increase quality of life after the selection of the Individual mode morphine pump. In patients with refractory cancer pain, intrathecal drug therapy with programmable morphine pumps is associated with improved pain reporting, reduced breakthrough pain and a significant improvement in the quality of life.

Biography :

Dongwoo John Chang currently working as Medical Director, CIGNA, USA. He completed his graduation in 1993 at Medical School - Temple University School of Medicine, USA. He is a Neurological Surgeon - General Practice in Rockford.

Email: chang16@llnl.gov