Pain Medicine 2015; 16: 21 Wiley Periodicals, Inc.
Response to Letter by Verdolin Dear Editor, Dr. Verdolin has raised a series of interesting issues related to intrathecal opioids. On one point, I certainly agree with him: the costs and safety of mixtures compounded by external pharmacies should result in the elimination of this method of treating patients. In well over 350 patients treated with intrathecal opioids, I never used compounded drugs and only used manufacturer-prepared morphine, sufentanil, or dilaudid. Indeed, the University of Washington Hospital would not allow compounded medications to be used in our institution. The evidence for polypharmacy is tenuous, in my opinion. As for the efficacy of ultra-low dose morphine, I am waiting for more well executed clinical trials before I am
willing to accept this method. There are patients whom I have tapered down off of high dose oral opioids as part of a multidisciplinary treatment program whose chronic pain was dramatically ameliorated without giving them low-dose intrathecal morphine. Human behavior is more complex than just the presence or absence of morphine in one’s spinal fluid. Nonspecific treatment effects are far more potent than the average proceduralist is willing to admit. Low-dose intrathecal morphine may turn out to be a very useful strategy, obviating many of the issues with traditional high-dose drug delivery. At the moment, it is merely a hypothesis deserving of explication. J.D. LOESER, MD Neurological Surgery, University of Washington Seattle, Washington, USA
21
Copyright of Pain Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Response to Letter by Verdolin Dear Editor, Dr. Verdolin has raised a series of interesting issues related to intrathecal opioids. On one point, I certainly agree with him: the costs and safety of mixtures compounded by external pharmacies should result in the elimination of this method of treating patients. In well over 350 patients treated with intrathecal opioids, I never used compounded drugs and only used manufacturer-prepared morphine, sufentanil, or dilaudid. Indeed, the University of Washington Hospital would not allow compounded medications to be used in our institution. The evidence for polypharmacy is tenuous, in my opinion. As for the efficacy of ultra-low dose morphine, I am waiting for more well executed clinical trials before I am
willing to accept this method. There are patients whom I have tapered down off of high dose oral opioids as part of a multidisciplinary treatment program whose chronic pain was dramatically ameliorated without giving them low-dose intrathecal morphine. Human behavior is more complex than just the presence or absence of morphine in one’s spinal fluid. Nonspecific treatment effects are far more potent than the average proceduralist is willing to admit. Low-dose intrathecal morphine may turn out to be a very useful strategy, obviating many of the issues with traditional high-dose drug delivery. At the moment, it is merely a hypothesis deserving of explication. J.D. LOESER, MD Neurological Surgery, University of Washington Seattle, Washington, USA
21
Copyright of Pain Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
