Abstract

PAPA, Patricia; BUELA, Leticia  and  PRINZO, Humberto. Programmable intrathecal morphine infusion pump in a patient with refractory oncological pain. Rev. Méd. Urug. [online]. 2024, vol.40, n.3, e702.  Epub Sep 13, 2024. ISSN 0303-3295.  https://doi.org/10.29193/rmu.40.3.8.

Pain control is one of the most important challenges in the field of palliative care and has a profound impact on patients’ quality of life. In most cases, severe oncological chronic pain can be managed with opioids; however, there is a population of patients, estimated to be between 10% and 20%, who experience refractory pain that requires more complex approaches. In patients with intractable pain or intolerable adverse effects, therapy based on intrathecal opioid infusion should be considered as part of the therapeutic strategy. We present the case of a patient with a malignant tumor in the anterior mediastinum who had refractory pain despite high doses of opioids and adjuvants. Given the refractory nature of the symptom, it was decided to place an intrathecal morphine pump to reduce opioid doses and optimize analgesia. The initial dose is titrated progressively in response to the patient’s reports and clinical evaluation. The patient passed away peacefully and painlessly, with an intrathecal morphine dose of 4500 μg/day. It is concluded that the intrathecal administration of opioid analgesics through the implantation of programmable continuous infusion devices for patients with refractory oncological pain is an effective and safe strategy, based on evidence, that allows for the optimization of analgesia when other techniques have failed.

Keywords : Oncological pain; Intrathecal morphine; Programmable pump.

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