Are Implanted Morphine Pumps of Benefit in Treating the Pain of LSAA?
The basic issue of using chronic opioid therapy in pain patients is controversial, the issue of chronic opioid therapy in LSAA patients with pumps delivering morphine into the subarachnoid space is a very controversial issue. LSAA patients have true organic nociceptive pain (as opposed to neuropathic pain). Morphine pumps are expensive, require significant maintenance, and the subarachnoid catheters are prone to create arachnoid adhesions, cysts, etc, causing blockage and then requiring surgical revision. Patients become resistant to opioids (requiring ever-increasing dosages), they affect mental function, they often require additional drugs to control constipation, itching and somnolence. Opioids can produce significant alternations in respiratory, liver, endocrine, gastrointestinal, immune, nutritional and motor systems (Fox CD: Chronic Opioid Therapy: Another Reappraisal, Amer. Pain Soc. Bull., Jan/ Feb 2002). While implanted morphine pumps may be reasonable (risk versus benefit) fo
