Chronic nonmalignant pain

There is a single-blind, prospective placebo-controlled study, which looked at short-term efficacy, showing spinal morphine to be of benefit in the short term in patients with CNMP who have responded to systemic morphine but in whom side effects have become intolerable.34[III] There are many studies of good quality to support the long term use of intrathecal drug delivery in CNMP.35 [III], 36[III], 37[III], 38[III]

There are two randomized double blind placebo controlled trials supporting the use of intrathecal ziconotide in CNMP; however, the clinical significance was small, experience is extremely limited, and side effects were troublesome.39[II], 40[II]

For CNMP in particular, patient characteristics have to be clearly considered in selection; a three year prospective study of intrathecal opioid treatment for CNMP in patients with extreme pain showed improvement but that overall severity of pain remained high.41 [III]

Trialing is mandatory (see Chapter 31, Intrathecal drug delivery in the Practice and Procedures volume of this series).

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