Introduction of morphine pump implant intrathecal drug delivery technology
People will experience various kinds of pain in their lifetime, and according to the duration of the disease, we classify pain into acute pain and chronic pain. The impact on the body and mind is even greater than that of the primary disease itself!
For various kinds of intractable intractable chronic pain, common treatments such as neurodesis, which is limited because of the high risk and serious complications, and spinal cord electrical stimulation, which is performed by stimulating electrodes placed in specific segments of the epidural cavity and connected to a microcomputer pump implanted in the body to continuously send out tiny electric currents to stimulate the spinal cord and interfere with pain afferents to achieve analgesia, and then there is intraspinal drug delivery. The treatment of chronic pain. Intrathecal drug delivery is a type of intrathecal drug delivery, which has become part of the overall treatment plan of the disease and occupies a special place in the step analgesic therapy. Its outstanding advantages are the small dosage of the drug, the ability to produce definite analgesic effects without affecting motor, sensory and sympathetic functions, and the low incidence of adverse effects.
The indications for the application of intrathecal infusion system include.
1.Patients with advanced cancer pain who need to improve their quality of life.
2.Patients with chronic intractable pain whose systemic application of potent opioids is ineffective or ineffective and who cannot tolerate the adverse effects of systemic medication.
3.Patients whose intravertebral application of test doses of morphine can produce effective analgesia.
4. Patients who have undergone psychological assessment, are suitable for implantation therapy, and have no contraindications to implantation surgery, including sepsis, coagulation dysfunction, etc.
There are three main methods of intrathecal drug delivery, namely intrathecal single administration using the subarachnoid space puncture technique commonly used in anesthesia for a one-time drug infusion, and continuous infusion that is based on the subarachnoid space puncture technique with the placement of a catheter and the use of an external drug injection pump for continuous drug administration. And the internal pump implantation system injects drugs into the internal implantation pump after the implantation is completed, and the drugs are continuously input at a certain rate according to the microcomputer control system in the pump. Generally, one time intra-pump drug administration can be maintained for about 3 months, which is limited in clinical application due to the technical difficulty of its implantation and installation as well as its high price.
How to evaluate the effectiveness of chronic pain treatment? We can judge from the following aspects.
1. pain relief, which is the most intuitive feeling of the patient and is easily judged by subjective influence.
2. reduction in the dosage of painkillers (oral), which can replace high-dose oral medication by intrathecal administration of morphine pumps and reduce side effects.
3.Improvement of daily living ability, which has the most realistic significance for patients.
4. return to work.
5. improvement in other bodily functions.
Question one.
The patient is 60 years old, complaining of persistent pain in the left lower and middle abdomen that cannot be relieved, diagnosed with advanced gastric cancer that has lost the chance of surgical treatment, under treatment with oral chemotherapy drugs, currently in good general condition, the pain is still not satisfactorily controlled by daily oral mescaline (morphine controlled-release tablets) at a dose of 100 mg, may I ask if morphine implant pump treatment is applicable and when is it appropriate to use it?
Answer.
For patients with advanced cancer such as gastric cancer and pancreatic cancer, the best opportunity for surgical treatment is often lost. If it is very advanced, most of the patients will have serious malnutrition and decreased immunity, which is no longer suitable for buried pump interventions. We recommend that morphine should be given intrathecally as soon as possible to help patients combat the increasing severity of persistent pain.
Question 2.
A 72-year-old female patient complains of paroxysmal burning pain from the right side of her back to the right side of her anterior chest, which is severe and cannot be relieved, and seriously affects her life and sleep. The patient reports that the pain is severe and cannot be relieved.
Answer.
It is characterized by severe pain in the area of the affected nerve, which is of various nature, such as burning, stabbing, cutting, electric shock, tightness, etc. It is often characterized by painful hypersensitivity and painful abnormalities, and often seriously affects eating and sleeping. The pain is often severe and affects eating and sleeping, and is accompanied by depression and irritability. Once acute herpes zoster is diagnosed, it should be treated early. The principles of treatment are pain relief, antiviral, anti-inflammatory, shortening the course of the disease and local protection against secondary infection. The patient’s condition has developed for more than 9 months, and after a variety of antiviral and corticosteroid medications and nerve block treatments, the pain is still not effectively relieved, indicating that the treatment in the early stage of the disease is not timely enough and the efficacy is poor, once it enters the chronic stage, the invaded neuropathy is irreversible, at this time, the application of various drugs and nerve block treatments naturally have poor results. Morphine is the only opioid approved by the FDA for intrathecal analgesia via implantable pumps, with the advantages of small dosage, rapid onset of action, precise analgesic effect and low incidence of adverse reactions.