Intrathecal Morphine Infusion Therapy in Management of Chronic Pain: Present and Future Implementation in Korea

Abstract

Purpose: Intrathecal morphine pump (ITMP) infusion therapy is efficient in managing malignant and nonmalignant chronic pain refractory to standard treatment. However, the high cost of an ITMP is the greatest barrier for starting a patient on ITMP infusion therapy. Using the revised Korean reimbursement guidelines, we investigated the cost effectiveness of ITMP infusion therapy and conducted a patient survey.

Materials and methods: A retrospective chart review of 12 patients who underwent ITMP implantation was performed. Morphine dose escalation rates were calculated, and numeric rating scale (NRS) scores were compared before and after ITMP implantation. We surveyed patients who were already using an ITMP as well as those who were candidates for an ITMP. All survey data were collected through in-person interviews over 3 months. Data on the cost of medical treatment were collected and projected over time.

Results: The NRS score decreased during the follow-up period. The median morphine dose increased by 36.9% over the first year, and the median time required to reach a financial break-even point was 24.2 months. Patients were more satisfied with the efficacy of ITMP infusion therapy than with conventional therapy. The expected cost of ITMP implantation was KRW 4000000-5000000 in more than half of ITMP candidates scheduled to undergo implantation.

Conclusion: The high cost of initiating ITMP infusion therapy is challenging; however, the present results may encourage more patients to consider ITMP therapy.

Keywords: Intrathecal; cost; morphine; survey.

Fig. 1. Questionnaire completed by patients with an intrathecal morphine pump.

Fig. 2. Questionnaire completed by patients who were candidates for intrathecal morphine pump implantation.

Fig. 3. Change in morphine infusion rate in the 12 patients examined.

Fig. 4. The percentage of patients who preferred ITMP therapy over previous pain-management strategies. Data indicate the percentage (%) of patients stating that ITMP was better than conventional therapy. ITMP, intrathecal morphine pump.

Fig. 5. Comparison of numeric rating scale (NRS) pain scores before and after ITMP implantation. Z-statistic (based on positive ranks)=-3.068, p<0.001. ITMP, intrathecal morphine pump.

Fig. 6. Comparison of morphine-equivalent dose between patients with malignant and non-malignant pain.

Fig. 7. Adverse effects experienced by patients implanted with an intrathecal morphine pump.