Opioid Withdrawal Following Intrathecal Morphine Pump Explantation Managed with a Structured Oral Opioid Taper: A Case Study
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Intrathecal (IT) opioid therapy is an established treatment for refractory chronic pain. Abrupt discontinuation of intrathecal opioids, especially following pump explantation, can precipitate clinically significant opioid withdrawal. Evidence guiding optimal management of withdrawal in this setting remains limited. Case Presentation: We report the case of a female patient with chronic pain related to prior lumbar spine and hip surgery who underwent explantation of an intrathecal morphine pump due to logistical barriers to routine refill appointments. Following explantation, she developed classic opioid withdrawal symptoms including worsening pain, nausea, chills, diaphoresis, and diarrhea. She remained clinically stable without evidence of infection or a surgical complication. Treatment consisted of gabapentin 300 mg four times daily and a structured four-week taper of short-acting oxycodone, followed by tramadol 50 mg three times daily as needed for 10 days. All opioids were subsequently discontinued, and gabapentin was progressively tapered without recurrent withdrawal symptoms. Conclusion: This case demonstrates that a structured, individualized oral opioid taper combined with adjunctive nonopioid therapy may be an effective outpatient strategy for selected, clinically stable patients experiencing withdrawal after intrathecal opioid discontinuation. Since intrathecal-to-oral opioid conversions are highly variable, treatment should be guided by symptoms, tolerability, and close clinical reassessment rather than reliance on a single equianalgesic ratio.
Source: Psychopharmacology Bulletin
DOI: 10.64719/pb.21639
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225144783