[Demand-controlled continuous spinal-cerebral morphine administration via an implanted programmable pump]

Abstract

The significance of the demand-controlled spinal and cerebral administration of morphine has increased with the improvements in the variable techniques (including programmable implanted pumps). Continuous low-dose infusion enables sustained pain-free state with minimal risks and side effects, so that this method is also feasible for treatment of very severe therapy-resistant pain in benign conditions. Neurostimulation of the lemniscal system (dorsal columns of the spinal cord, specific thalamus, etc., especially in deafferentation pain) and surgical interruption of pain pathways and centers (especially in nociceptive pain) as a last resort continue to be indispensable. In our view, the assumption that spinal and cerebral application of morphine is not appropriate in deafferentation pain is not justified on the basis of the most recent discussions and our own observations. Merely higher doses are probably required for this type of pain.