Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration

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Abstract
Clinical trials for abatement of intractable pelvic cancer pain were conducted in 2 patients, each electing surgical implantation of 1 of 2 indwelling catheter systems for administration of morphine into the spinal epidural space. Both systems, 1 consisting of a partially indwelling Broviac catheter, and the other, completely indwelling, consisting of a morphine reservoir connected to a shunt pump and on-off Hakim valve assembly, permitted the patients to return home where they could self-administer epidural morphine. Each patient reported that 2 mg of epidural morphine provided 8-12 h of pain relief at a level superior to their previous systemic narcotic medication. On a regimen of 2 mg of epidural morphine administered twice daily, both patients experienced analgesia for 6 mo. unaccompanied by alterations in sensory, motor or congnitive functioning, and with little drug tolerance reaction.