When are intrathecal morphine pumps indicated for the treatment of chronic pain syndrome (CPS), and what are the recommendations for noninvasive brain stimulation?

Updated: Jan 14, 2020
  • Author: Manish K Singh, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Intrathecal morphine pumps, either fully implantable or external, are used to treat chronic pain. Use of these devices should be considered very carefully for pain of nonmalignant origin, with a preprocedure psychological/psychiatric patient examination being included in the evaluation. A successful intrathecal morphine pump trial is required prior to implantation of the pump.

A literature review by Baptista et al yielded consensus recommendations on the use of noninvasive brain stimulation in the management of chronic pain in Latin America and the Caribbean region. These include the following, with the investigators specifying that low to moderate analgesic effects can be obtained in association with level A recommendations, while potential, but uncertain benefits, are associated with level B recommendations [32] :

  • The use of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex was recommended for the control of fibromyalgia pain (level A), as well as for peripheral neuropathic pain, abdominal pain, and migraine (level B)
  • Bifrontal (F3/F4) tDCS and high-definition (HD) tDCS over the primary motor cortex were recommended for the treatment of fibromyalgia (level B)
  • Occipital/top-of-the head (Oz/Cz) tDCS was recommended for migraine treatment (level B)
  • High-frequency repetitive transcranial magnetic stimulation (HF rTMS) over the primary motor cortex was recommended for fibromyalgia and neuropathic pain (level A), as well as for myofascial pain, musculoskeletal pain, complex regional pain syndrome, and migraine (level B)
  • A recommendation was made against the treatment of low back pain with primary motor cortex tDCS
  • A recommendation was made against the treatment of chronic pain with HF rTMS over the left dorsolateral prefrontal cortex

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