Efficacy of intrathecal morphine pump in a case of peripheral neuropathic pain developed after bortezomib

Abstract

Bortezomib is a newly developed proteozom inhibitor used in many cancer types. It is widely used particularly in newly diagnosed or resistant type multiple myeloma cases due to its inhibitory effect on nuclear factor kappa B (NF?B) which induces myeloma signal in bone marrow. Its most important side effect is a severe neuropathic pain that can even require stopping the treatment. The present case report describes implantation of intrathecal morphine pump in a case where no response could be obtained to the high dose systemic treatment. Following the intrathecal morphine injection, the paresthesia, thermal hyperalgesia and pain disappeared. It was observed that the severe pain which could not be controlled by a systemic morphine dose of 90 mg/day disappeared completely with just a 0.1 mg/day dosage. It may be suggested that intrathecal morphine pump implantation with very small doses of morphine can be an effective and safe alternative when pain could not be controlled by other methods.