Intrathecal Morphine Infusion Therapy via a Percutaneous Port for Refractory Cancer Pain in China: An Efficacy, Safety and Cost Utilization Analysis

Wangjun Qin, 1 Yifan Li, 2 Botao Liu, 2 Ying Liu, 1 Yi Zhang, 2 Xianglin Zhang, 1 Pengmei Li, 1 Bifa Fan 2 1Department of Pharmacy, China–Japan Friendship Hospital, Beijing, People’s Republic of China; 2Department of Pain Management, China–Japan Friendship Hospital, Beijing, People’s Republic of ChinaCorrespondence: Pengmei Li; Bifa Fan 2 Yinghua Dongjie, Hepingli, Beijing 100029, People’s Republic of ChinaTel/Fax +86 10 8420 5330; +86 10 84205959Email article2019@163.com; fyinsuo@yeah.netPurpose: Intrathecal morphine infusion therapy via a percutaneous port (IMITPP) has been used widely for its relatively low initial cost. However, there is scarce knowledge about IMITPP. In this study, we sought to evaluate efficacy, complications, and the interval required to achieve the cost equivalence of IMITPP in patients with refractory cancer pain in China.Patients and Methods: A retrospective chart review was conducted on cancer patients who had received IMITPP at our hospital between April 2017 and April 2019. Data from the numeric pain rating scale and Karnofsky performance scores, and complications and costs related to IMITPP were collected from medical records. Daily analgesic costs before and after IMITPP were calculated based on the doses of opioids on admission and at discharge, respectively. The doses of systemic opioids before IMITPP were stratified into very high doses [VHD, oral morphine equivalent dose (OMED) > 599 mg/day], high doses (HD, 300 mg/day ≤ OMED ≤ 599 mg/day), and regular doses (RD, OMED < 300 mg/day).Results: Intrathecal morphine infusion therapy via a percutaneous port provided significant pain relief, but impaired activities of daily living in patients with refractory cancer pain. The commonly reported complications included nausea/vomiting and urinary retention, most of which were managed with symptomatic therapies. The median interval required to achieve cost equivalence was 11.44 months. The median intervals of VHD group and HD group were significantly shorter than that of RD group.Conclusion: Intrathecal morphine infusion therapy via a percutaneous port provided effective cancer pain management without causing serious complications. Patients with higher doses of systemic opioids would economically benefit from IMITPP in a shorter time.Keywords: intrathecal, morphine, port catheter, cost-benefit analysis, cancer pain