Hello, my name is Muhammad Jalal, and I will be presenting on the following abstract. Efficacy of Ultramicrodose Intrathecal Morphine Delivery in the Treatment of Chronic Pain. Authors and affiliations are listed. For disclosures, both authors have nothing to disclose. Here's an overview of this presentation. We'll begin with an introduction, move on to our methods, and finish with our results and discussion. Introduction. Low-dose intrathecal morphine via an intrathecal drug delivery system has been shown as a promising alternative to the treatment of chronic pain. This treatment has also gained increasing interest due to the opioid epidemic, as it's an alternative to oral analgesics. However, in the literature, what constitutes a low or a microdose of morphine delivered via this intrathecal device has not been made clear. This study sought to elucidate the efficacy of what we defined as ultramicrodoses of intrathecal morphine, which we defined as less than 0.20 mg in the treatment of chronic pain. Methods. So we began with the enrollment in the trial. Patients were enrolled at St. James Mercy Hospital, University of Rochester in New York from February 2016 to February 2020. An outpatient intrathecal morphine trial was performed by injecting a single dose of 0.1 to 0.3 mg of preservative-free morphine in the lumbar intrathecal space. Showing at least a 60% reduction in pain compared to the baseline, a permanent intrathecal catheter and morphine pump was implanted. The drug delivery system was programmed to deliver ultramicrodoses of morphine, which in our cohort ranged from 0.065 mg to 0.195 mg over a 24-hour period in a simple, continuous, or flexible mode. The safety and efficacy of this treatment for the treatment of chronic pain was then assessed. So here is some demographic data about our patients. The median age was 57. There was 33 patients in this cohort, with 20 of them being female and 13 being male. For pain at diagnosis, the median was 10, and the Q1 to Q3 was 10 out of 10, and this was on the 0 to 10 pain scale. For intrathecal morphine ultramicrodose, the median dosage was 0.1450 mg, and the Q1 was 0.1100 mg, and the Q3 was 0.1521 mg. And these are some of the treatments, or some of the diagnoses that were treated. They included chronic pain syndrome and post-laminectomy syndrome, which accounted for the majority of our patients, but there was also some patients with MS, chronic regional pain syndrome, and diffuse idiopathic skeletal hyperptosis. And this is a diagram, or a figure that's showing some of our results. So on the right side, we have the pain plotted before treatment. Again, the median was 10 out of 10. And then on the left, we have the change in pain due to treatment. And this was found to be statistically significant, with a p-value much less than 0.001. And this table shows the same results. So the pain at diagnosis was, again, a median of 10, with a Q1 and Q3 of 10 to 10. The pain at this 12 to 16-month follow-up was 0, with a Q1 of 0 and a Q3 of 2.00. And then for pain level of 0 at follow-up, 17 out of the 33 patients, or 51.5%, reported no pain. Furthermore, there was no infections and no complications in our study. And then again, this was our ultramicrodose. And the median was 0.145 milligrams, with that Q1 of 0.1100 and a Q3 of 0.1521 milligrams. So for conclusion, ultramicrodoses of intrathecal morphine administered in this manner via that intrathecal drug delivery system were found to significantly reduce pain in these patients. And furthermore, they were able to do so without complication and without infection. And these promising results lead us to desire a future multicenter study. The references are listed here. And thank you for your time.

Muhammad Jalal

ultramicrodose intrathecal morphine delivery

chronic pain treatment

efficacy

St. James Mercy Hospital