• Denise M Wilkes, Susan J Orillosa, Erik C Hustak, Courtney G Williams, Gulshan R Doulatram, Daneshvari R Solanki, Eduardo A Garcia, and Li-Yen M Huang.
• Department of Anesthesiology and Pain Medicine, University of Texas Medical Branch, Galveston, Texas.
• Pain Med. 2018 Sep 1; 19 (9): 1782-1789.

ObjectivesThe goal of this study was to assess the success of the morphine microdose method in a community pain clinic setting by monitoring follow-up frequency, dose escalation, and monotherapy/polytherapy ratio. The morphine microdose method involves a pretrial reduction or elimination of systemic opioids followed by a period of abstinence. Intrathecal (IT) morphine is then started at doses of less than 0.2 mg per day. Systemic opioid abstinence is then continued after pump implant and IT morphine monotherapy.DesignRetrospective review of medical records.SettingPrivate and academic pain clinic practices.SubjectsChronic noncancer pain patients.MethodsWe reviewed the charts of 60 patients who had completed a microdose regimen and had an IT pump implanted between June 11, 2008, and October 11, 2014. During IT therapy, dose change over time, pain scores, side effects, max dose, and duration were recorded.ResultsThe majority of patients (35/60, 58%) were successfully managed solely on morphine microdose monotherapy. These patients did not require additional oral therapy. There was a significant reduction in mean pain scores, from 7.4 ± 0.32 before microdose therapy to 4.8 ± 0.3 after microdose therapy.ConclusionsMicrodose therapy achieved analgesia, improved safety, and avoided systemic side effects. The safety of IT therapy was increased by using a lower concentration (2 mg/mL) and lower daily doses (<3 mg/d) of morphine. Furthermore, microdose therapy was feasible, safe, and cost-effective in the outpatient setting.

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