Intrathecal Morphine Therapy for Chronic Non-malignant Pain Using a Constant Flow Infusion System Jairo Angelos, Martin Paiz, Christiane Pellegrino Rosa, Roberta Risso, Bernardo Monaco, Kleber Paiva Duarte, William Omar Contreras Lopez, Manoel Jacobsen Teixeira and Erich Talamoni Fonoff* Pain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil *Corresponding author: Erich Talamoni Fonoff, Division of Functional Neurosurgery, Hospital das Clínicas, University of São Paulo, Rua Dr Ovídio Pires de Campos, 785, São Paulo, SP, Brazil, 01060-970, Tel +55 11 2661 6402; Fax +55 11 2661 6402; E-mail: fonoffet@usp.br Rec date: Nov 25, 2014; Acc date: Dec 30, 2014; Pub date: Jan 02, 2015 Copyright: © 2014 Angelos J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited Abstract Background: Implantable pumps for intrathecal opioid therapy in the last decades emerged as one of the most effective treatment for chronic non-malignant pain (CNMP) in selected patients. This study analyses reliability of intrathecal infusion morphine therapy for chronic and refractory pain not related to malignancy using an implantable constant flow pump. Methods: we studied eleven patients (9 women and 2 men; age range 26-67 years), with medically unresponsive CNMP. Pain was classified as neuropathic or non-neuropathic based on clinical features. Patients were evaluated before and after pump implantation, measuring pain intensity and relief after intrathecal opioid treatment based on Visual Analogic Scale (VAS) scores. Results: Pain significantly reduced in almost all patients (91%); mean pain scores improved from 8.9 ± 1.49 before implant to 66% improvement one month after infusion therapy (3.1 ± 1.60) and 41% after 18 months (5.2 ± 2.45). Conclusion: The present data show that intrathecal morphine infusion at a constant flow proved to be a safe and suitable alternative for the treatment of CNMP. Keywords: Chronic non-malignant pain (CNMP); Failed back surgery syndrome (FBSS); Neuropathic pain; Intrathecal morphine Therapy; Spinal infusion pump Introduction Chronic non-malignant pain (CNMP) is a disabling complex entity affecting professional performance, limiting psychological and social capacities, family relationships, consequently affecting mental health status and quality of life [1]. It`s difficult to achieve an effective and stable treatment in majority of cases, so that more effective therapeutic methods are needed to manage these patients and prevent a deteriorating performance in their daily life activities [2]. As a therapeutic option for CNMP, intrathecal pain therapy provided by implantable infusion systems allows drug administration directly in cerebral spinal fluid (CSF) within the spinal canal in a safe and precise manner with long autonomy. They have been used in the management of selected cases of pain and severe spasticity. [3] Recognized indications for intrathecal opioid delivery are failed back surgery syndrome (FBSS) [4], neuropathic pain, complex regional pain syndrome (CRPS), pain after spinal cord injury [5], pain resistant to spinal cord stimulation [6], spinal arachnoiditis, peripheral neuropathy, among others. Authors have reported that chronic intrathecal morphine infusion is a safe and effective option [7-9] since it does not require a significant systemic drug concentration to provide a good pain relief [10]. Very low concentrations of drugs delivered intrathecally are found in systemic circulation, what lowers the occurrence of adverse effects [11]. As a drawback, the need of a subcutaneous tissue implant and intrathecal space catheterization can originate catheter related problems (dislocations, disconnections, rupture and obstruction), pump dysfunctions and inflammatory processes, which are rare in general [8]. Tricumed infusion pump IP2000V (Tricumed Medizintechnik GmbH Röntgenstrasse 7a; 24143 Kiel, Germany, see Figure 1A) is an implantable device that is intended to store and deliver pharmacological agents at a constant rate. The IP2000V pump delivers fluid solutions from the reservoir to the device outlet through a combination of a pressurized fluid reservoir through a capillary chip and associated fluid channeling. It is supposed to be used for the delivery of morphine sulphate for continuous intrathecal pain therapy and intrathecal baclofen for spasticity. Here we aimed to study clinical results, complications and side effects of intrathecal morphine therapy at a constant infusion flow in CNMP patients. Methods A prospective and observational analysis of all patients using Tricumed IP2000V infusion pump was performed at Pain Center and Division of Functional Neurosurgery, University of São Paulo, Brazil. Angelos et al., J Pain Relief 2015, 4:1 DOI: 10.4172/2167-0846.1000168 Research Article Open Access J Pain Relief ISSN:2167-0846 JPAR, an Open Access Volume 4 • Issue 1 • 1000168 Journal of Pain & Relief J o u r n a l o f P a i n & R e l i e f ISSN: 2167-0846