Intraarticular Morphine Analgesia in Chronic Pain Patients with Osteoarthritis

Abstract

Controlled clinical studies have shown that local administration of morphine can significantly relieve acute postoperative pain. This analgesic effect is long-lasting (up to 48 h) and is mediated by peripheral opioid receptors. Experimental evidence shows that analgesic effects of peripheral opioids and the density of opioid receptors on peripheral sensory nerves increase with the duration of painful inflammatory processes. This study examines the analgesic effects of 1 mg of morphine injected into the arthritic knee joints of two groups of chronic pain patients (n = 23) suffering from osteoarthritis. Using a randomized, double-blind cross-over design, patients received either an intraarticular injection of morphine and intravenous saline (Group A, n = 13) or an intraarticular injection of saline and intravenous morphine (Group B, n = 10) during Phase I. Seven days later, patients crossed over to the opposite treatment (Phase II). During Phase I, intraarticular morphine resulted in significantly greater pain relief than intraarticular saline, and this effect was present at rest as well as during movement. The analgesic effect was surprisingly long-lasting and extended into Phase II, a carry-over effect that prevented the analysis of Phase II. No side effects were reported. The treatment of arthritic pain by peripherally acting opioids may be a promising alternative to currently available medications that have serious side effects.

Perineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results

“…Therefore, the peripheral administration of opioid agonists may, theoretically, inhibit the chronic pain of infl ammation under ischemic conditions in PVD. Locally administered opioids have been shown to elicit effective analgesic effects in various acute and chronic clinical pain syndromes, including burn pain [27], infl ammatory pain [28], osteoarthritis [7], and rheumatoid arthritis [29], as well as after dental [11], urinary bladder [30], and knee surgery [31], too. In the present study we used morphine as an adjunct to bupivacaine through a popliteal catheter in chronic pain due to PVD, based on the interaction between opioids and infl ammatory conditions and also based on clinical trials as mentioned above.…”

“…Previous studies have shown that perineural opioids on top of local anesthetics prolong postoperative analgesia and that this kind of analgesia is mediated by peripheral opioid receptors [5][6][7][8][9]. These peripheral analgesic effects of opioids are predominant under infl ammatory conditions [10][11][12].…”

Peripheral opioid analgesia: Clinical applications

“…In chronic pain states such as rheumatoid and osteoarthritis, intra-articular morphine injections elicited pain relief of longer duration (up to 7 days) [32,33]. This may be the result of analgesic and anti-inflammatory effects of locally applied opioids.…”

“…Likar et al [32] could show that a single dose of 1-mg intra-articular morphine into the knee joint of patients with chronic osteoarthritis resulted in a significant reduction in pain intensity at rest and during movement with a longlasting effect up to 1 week. Similar results were seen by Stein et al [33] who were treating patients with rheumatoid arthritis or osteoarthritis.…”

Blockade of intra-articular adrenergic receptors increases analgesic demands for pain relief after knee surgery

“…In humans, the local (i.a.) injection of small, systemically inactive doses of morphine has been shown to produce potent analgesia in acute and chronic arthritis (e.g., knee surgery, rheumatoid and osteoarthritis) [7][8][9][10]. As a result, several medical societies have meanwhile adopted i.a.…”