Efficacy, safety, and feasibility of the morphine microdose method in community-based clinics

Objectives. The goal of this study was to assess the success of the morphine microdose method in a community pain clinic setting by monitoring followup frequency, dose escalation, and monotherapy/ polytherapy ratio. The morphine microdose method involves a pretrial reduction or elimination of systemic opioids followed by a period of abstinence. Intrathecal (IT) morphine is then started at doses of less than 0.2mg per day. Systemic opioid abstinence is then continued after pump implant and IT morphine monotherapy. Design. Retrospective review of medical records. Setting. Private and academic pain clinic practices. Subjects. Chronic noncancer pain patients. Methods. We reviewed the charts of 60 patients who had completed a microdose regimen and had an IT pump implanted between June 11, 2008, and October 11, 2014. During IT therapy, dose change over time, pain scores, side effects, max dose, and duration were recorded. Results. The majority of patients (35/60, 58%) were successfully managed solely on morphine microdose monotherapy. These patients did not require additional oral therapy. There was a significant reduction in mean pain scores, from 7.4±0.32 before microdose therapy to 4.8±0.3 after microdose therapy. Conclusions. Microdose therapy achieved analgesia, improved safety, and avoided systemic side effects. The safety of IT therapy was increased by using a lower concentration (2 mg/mL) and lower daily doses (>3 mg/d) of morphine. Furthermore, microdose therapy was feasible, safe, and costeffective in the outpatient setting.