Intrathecal Morphine Pump as a Treatment Option in Chronic Pain of Nonmalignant Origin

Angel, Ian; Gould, Harry J.; Carey, Michael E.

doi:10.1016/s0090-3019(97)00287-5

Cited by 65 publications

(2 citation statements)

References 16 publications

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“…The value of epidural injections for the treatment of existing PHN has not been evaluated 106. Continuous infusions of analgesic agents (typically an opioid or local anesthetic) via an externalized intrathecal catheter or an internalized intrathecal pump may also be used for the treatment of PHN, although no controlled trials examining the analgesic efficacy of these modalities are available 110,111…”

Section: Resultsmentioning

confidence: 99%

Post-herpetic neuralgia

Parruti¹,

Tontodonati²,

Ursini³

et al. 2012

IJGM

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BackgroundIn spite of the large body of evidence available in the literature, definition and treatment of Post-Herpetic Neuralgia (PHN) are still lacking a consistent and universally recognized standardization. Furthermore, many issues concerning diagnosis, prediction and prevention of PHN need to be clarified in view of recent contributions.ObjectivesTo assess whether PHN may be better defined, predicted, treated and prevented in light of recent data, and whether available alternative or adjunctive therapies may improve pain relief in treatment recalcitrant PHN.MethodsSystematic reviews, meta-analyses, randomized controlled trials, cohort studies and protocols were searched; the search sources included PubMed, Cochrane Library, NICE, and DARE. More than 130 papers were selected and evaluated.ResultsDiagnosis of PHN is essentially clinical, but it can be improved by resorting to the many tools available, including some practical and accessible questionnaires. Prediction of PHN can be now much more accurate, taking into consideration a few well validated clinical and anamnestic variables. Treatment of PHN is presently based on a well characterized array of drugs and drug associations, including, among others, tricyclic antidepressants, gabapentinoids, opioids and many topical formulations. It is still unsatisfactory, however, in a substantial proportion of patients, especially those with many comorbidities and intense pain at herpes zoster (HZ) presentation, so that this frequent complication of HZ still strongly impacts on the quality of life of affected patients.ConclusionFurther efforts are needed to improve the management of PHN. Potentially relevant interventions may include early antiviral therapy of acute HZ, prevention of HZ by adult vaccination, as well as new therapeutic approaches for patients experiencing PHN.

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Section: Resultsmentioning

confidence: 99%

Post-herpetic neuralgia

Parruti¹,

Tontodonati²,

Ursini³

et al. 2012

IJGM

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“…Several studies have shown the successful treatment of CNS injury using osmotic mini-pumps in rodents. However, many of these studies do not demonstrate efficacy following chronic implantation in the spinal cord, either due to experimental design (only measuring acute time points), complications exacerbated by the implantation of the pump, such as tissue ablation, catheter failure, dislodgment or obstruction, and inconsistent/adverse drug delivery (de Yebenes et al, 1987;Bear et al, 1990;Lu and Hagg, 1997;Angel et al, 1998;Hodgetts et al, 2013). These limitations demonstrate the difficulty of microinfusing blood-brain-barrier impermeable agents which must be given directly to the spinal cord and/or injury site.…”

Section: Discussionmentioning

confidence: 99%

Acute Cellular and Functional Changes With a Combinatorial Treatment of Ion Channel Inhibitors Following Spinal Cord Injury

Doig

Santhakumar

Fehily

et al. 2020

Front. Mol. Neurosci.

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Reducing the extent of secondary degeneration following spinal cord injury (SCI) is necessary to preserve function, but treatment options have thus far been limited. A combination of the ion channel inhibitors Lomerizine (Lom), YM872 and oxATP, to inhibit voltage-gated Ca 2+ channels, Ca 2+ permeable AMPA receptors, and purinergic P2X 7 receptors respectively, effectively limits secondary consequences of injury in in vitro and in vivo models of CNS injury. Here, we investigated the efficacy of these inhibitors in a clinically relevant model of SCI. Fischer (F344) rats were subjected to a moderate (150 kD) contusive SCI at thoracic level T10 and assessed at 2 weeks or 10 weeks post-injury. Lom was delivered orally twice daily and YM872 and oxATP were delivered via osmotic mini-pump implanted at the time of SCI until 2 weeks following injury. Open field locomotion analysis revealed that treatment with the three inhibitors in combination improved the rate of functional recovery of the hind limb (compared to controls) as early as 1-day post-injury, with beneficial effects persisting to 14 days post-injury, while all three inhibitors were present. At 2 weeks following combinatorial treatment, the functional improvement was associated with significantly decreased cyst size, increased immunoreactivity of β-III tubulin +ve axons, myelin basic protein, and reduced lipid peroxidation by-products, and increased CC1 +ve oligodendrocytes and NG2 +ve /PDGFα +ve oligodendrocyte progenitor cell densities, compared to vehicle-treated SCI animals. The combination of Lom, oxATP, and YM872 shows preclinical promise for control of secondary degeneration following SCI, and further investigation of long-term sustained treatment is warranted.

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Long-term opioid management for chronic noncancer pain

Noble

Treadwell

Tregear

et al. 2010

Cochrane Database of Systematic Reviews

402

161

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Many patients discontinue long-term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare.

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Intrathecal Morphine Pump as a Treatment Option in Chronic Pain of Nonmalignant Origin

Cited by 65 publications

References 16 publications

Post-herpetic neuralgia

Post-herpetic neuralgia

Acute Cellular and Functional Changes With a Combinatorial Treatment of Ion Channel Inhibitors Following Spinal Cord Injury

Long-term opioid management for chronic noncancer pain

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