Abstracts
22 September 2025
Vol. 2 No. s1 (2025): 48th National Conference of the Italian Association for the Study of Pain
https://doi.org/10.4081/ahr.2025.62

INTRATHECAL MORPHINE THERAPY FOR CHRONIC BENIGN NEUROPATHIC PAIN: A CASE REPORT

V. Donatiello1, M. Alfieri2, A. Scalvenzi1, F. Mattozzi2, A. Cangiano2, A.R. Tonci2, P. Buonavolontà2 | 1Dept. of Elective Anesthesiological Activities ", "AORN A. Cardarelli" Hospital Napoli; 2Pain Unit "AORN A. Cardarelli" Hospital, Napoli

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INTRODUCTION
Chronic neuropathic pain is a challenging condition requiring multimodal management. Intrathecal drug delivery (IDD) is an effective approach for patients with refractory pain who cannot tolerate systemic medications or are ineligible for neuromodulation. This case report describes a 53-year-old Caucasian woman with chronic dorsolumbar neuropathic pain and upper limb weakness after T8-T9 herniectomy with laminoartropeduncolectomy. Given her poor tolerance to systemic analgesics and contraindication for spinal cord stimulation (SCS) due to intrathecal calcifications, intrathecal morphine therapy was implemented.
CASE REPORT
The patient, previously healthy, experienced persistent neuropathic pain and upper limb weakness following surgery for a T8-T9 disc herniation. Her pain was refractory to gabapentin (200 mg/day) and transdermal fentanyl (25 mcg/day). Dose escalation was not possible due to side effects. SCS was contraindicated due to intracanal calcifications at T7-T8 and T8-T9 on CT imaging. A test dose of intrathecal morphine (0.1 mg) provided significant pain relief without adverse effects. Consequently, an intrathecal drug delivery system (IDDS) was implanted, administering morphine at 0.5 mg/day. The device used was a SynchroMed II pump (Medtronic). Post-implantation, the patient reported significant pain reduction, improved quality of life, and no complications.
DISCUSSION
This case highlights the potential of intrathecal morphine therapy for chronic neuropathic pain in patients contraindicated for other interventions. IDDS is beneficial for those who cannot tolerate systemic opioids or undergo SCS. Intrathecal opioid administration allows for lower dosages, reducing systemic side effects while providing effective analgesia. Careful patient selection and monitoring are crucial to optimize outcomes and minimize risks such as catheter-related complications and opioid-induced endocrinopathies. This case supports intrathecal morphine as a viable treatment for refractory neuropathic pain when other options are unavailable. Further studies are needed to evaluate long-term outcomes and optimize treatment protocols. Informed consent was obtained from the patient for publication.

 

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1.
INTRATHECAL MORPHINE THERAPY FOR CHRONIC BENIGN NEUROPATHIC PAIN: A CASE REPORT: V. Donatiello1, M. Alfieri2, A. Scalvenzi1, F. Mattozzi2, A. Cangiano2, A.R. Tonci2, P. Buonavolontà2 | 1Dept. of Elective Anesthesiological Activities ", "AORN A. Cardarelli" Hospital Napoli; 2Pain Unit "AORN A. Cardarelli" Hospital, Napoli. Adv Health Res [Internet]. 2025 Sep. 22 [cited 2025 Oct. 14];2(s1). Available from: https://www.ahr-journal.org/site/article/view/62
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