Intraspinal morphine for cancer pain

Abstract

From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow‐up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long‐term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side‐effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.

Intrathecal pumps for giving opioids in chronic pain: a systematic review.

“…Brazenor 22 suggested that its incidence was increased with more cephalic positioning of the intrathecal catheter. • Ventafridda and co-workers, 62 in a retrospective review of 412 patients, documented less nausea and vomiting when using the epidural route (18%) than the intrathecal (40%). • The use of systemically administered breakthrough opioids may contribute to the overall incidence of nausea and vomiting.…”

“…24 to 51%. 62 The majority comment on the transient nature of these symptoms. • The use of local anaesthetic would appear to reduce the incidence to 2-3%.…”

Intrathecal Ziconotide in the Treatment of Refractory Pain in Patients With Cancer or AIDS

“…Many patients with cancer or AIDS do not receive satisfactory pain relief 7,8 from systemic administration of opioids and become potential candidates for intraspinal analgesia. [9][10][11] However, regardless of delivery route, concerns about addiction and abuse, and the potential for developing tolerance, adverse effects, and pain refractoriness limit the effectiveness of opioids.…”

Infusão intratecal de opióides para tratamento de dor crônica não decorrente de câncer

“…É possível, portanto, que a infusão de antagonistas NMDA possa diminuir tolerância aos opióides (Dunbar e Yaksh, 1997) e que a tolerância possa ser evitada com interrupções programadas da administração de opióides. Os achados do presente estudo também concordam com os de trabalhos recentes que demonstraram que ocorre, ao longo do tempo, estabilização da dose dos opióides utilizados prolongadamente por (Twycross, 1974;Ventafridda et al, 1987aVentafridda et al, e 1987bTakeda, 1986;Vijayaram et al, 1989;Portenoy et al, 1990;Schug et al, 1990), ou via espinal (Onofrio et al, 1981;Coombs et al, 1982;Harbaugh et al, 1982;Penn et al, 1984;Spaziante et al, 1985;Krames et al, 1985;Wang, 1985;Shetter et al, 1986;Brazenor, 1987;Penn e Paice, 1987;Hassenbusch et al, 1995) VO para tratar a dor.…”

“…passou-se a considerar que os mesmos não causavam invariavelmente dependência ou tolerância. A modificação baseou-se principalmente na boa resposta ao tratamento prolongado com opióides no tratamento da dor causada por câncer; evidenciou-se que ocorria melhora funcional e da qualidade de vida de 70% a 90% dos doentes assim tratados (Takeda, 1986;Ventafridda et al, 1987aVentafridda et al, e 1987bVijayaram et al, 1989;Schug et al, 1990).…”