Intraventricular morphine for intractable craniofacial pain.
This case management report on a patient with advanced craniofacial neoplasm discusses the successful treatment of chronic pain by the cortical intraventricular narcotic administration. A previously treated patient with surgery and radiotherapy for carcinoma of the palate developed severe intractable pain despite high dose oral morphine therapy. Investigations revealed that neoplasm had reoccurred with extensive infiltration. Intraventricular morphine therapy was discussed and accepted by the patient and family. A ventricular shunt with an Ommaya reservoir was inserted under local anaesthesia. Preservative-free morphine sulphate in increasing doses of 0.25 to 1 mg was administered, once daily, which kept the patient in a pain-free state. The treatment was initiated in the hospital and continued at home till the demise of the patient on the 9th week. The home care was provided by the nurses of Home Nursing Foundation and Singapore Cancer Society under physician supervision. There were no complications which had been reported in the literature, observed in the management of this patient.