Long Term Intrathecal Infusion of Opiates for Treatment of Failed Back Surgery Syndrome

Lara, Nilton Alves; Teixeira, Manoel Jacobsen; Fonoff, Erich Talamoni

doi:10.1007/978-3-211-99370-5_8

Cited by 19 publications

(13 citation statements)

References 35 publications

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“…Results were excellent in 50% of cases of central NP and good in remaining cases, during a follow up period with mean duration of 21 months; adverse effects were uncommon and there has been no infection or operational problems with the implanted system. In Brazil, results have been reported as satisfactory in different types of NP refractory to oral drugs, reaffirming the method to treat painful syndromes of difficult clinical and even surgical control 37,38 . However, there are adverse effects from those directly related to drug effect on central receptors to effect on hypothalamic-pituitary axis with hormonal and bone metabolism changes.…”

Section: Spinal Infusion Of Analgesic Drugsmentioning

confidence: 75%

“…In the 1970s, other authors (Mazars, 1973) have reported the first experience with chronic stimulation of thalamic sensory nuclei to treat NP 36 . Other authors have reported long term success with somesthetic thalamic stimulation and later the target has shifted to periaqueductal gray matter (PAG) and periventricular gray matter (PVG) of the III ventricle 37 .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

“…They may release drugs in the spinal, cisternal and intraventricular space. Spinal release is the most effective because the dose needed to control pain is the lowest possible and with this, in general, there is no drug in systemic circulation 37 .…”

Section: Spinal Infusion Of Analgesic Drugsmentioning

confidence: 99%

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Central neuropathic pain

Garcia¹,

Neto

Amâncio³

et al. 2016

Revista Dor

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and Pubmed databases in the last 10 years were selected by means of keywords: chronic neuropathic pain, central neuropathic pain, central pain. CONCLUSION: Central painful syndrome is diagnosed by means of neurological clinical evaluation. It is often refractory to clinical and neuromodulatory treatment, its management should be multimodal and allow for rehabilitation. Keywords: Central neuropathic pain, Central pain, Chronic neuropathic pain. RESUMO JUSTIFICATIVA E OBJETIVOS:A dor central, classificada como neuropática, é definida como uma síndrome dolorosa que decorre da lesão de estruturas no sistema nervoso central. Trata-se de uma das síndromes dolorosas mais complexas, intrigantes e de difícil tratamento. O objetivo deste estudo foi promover uma revisão narrativa que inclui desde o conceito de dor central, seus sintomas intercorrentes importantes no diagnóstico; e diversos tratamentos disponíveis, indicações, resultados e complicações. CONTEÚDO: Foi realizada uma seleção de artigos relevantes disponíveis nas plataformas Medline, Scielo, Biblioteca Cochrane e Pubmed nos últimos 10 anos, por meio dos descritores: dor crônica neuropática, dor neuropática central, dor central. CONCLUSÃO: A síndrome dolorosa central tem seu diagnóstico realizado por meio do exame clínico neurológico. É frequentemente refratária ao tratamento clínico e neuromodulatório e, portanto, deve ser multimodal e permitir a reabilitação. Descritores: Dor central, Dor crônica neuropática, Dor neuropática central.

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Section: Spinal Infusion Of Analgesic Drugsmentioning

confidence: 75%

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

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Central neuropathic pain

Garcia¹,

Neto

Amâncio³

et al. 2016

Revista Dor

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“…The constant infusion, however, is the most diffused method of IT drug administration, and the comparison between bolus and constant-flow pumps shows no difference as concerning efficacy and safety in non-cancer pain (46,47) and cancer pain (48).…”

Section: It Drugsmentioning

confidence: 99%

Intrathecal Drug Administration for the Treatment of Cancer and Non-Cancer Chronic Pain

Raffaeli¹,

Magnani²,

Andruccioli³

et al. 2012

Topics in Neuromodulation Treatment

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More than 50% of cancer patients do not undergo adequate pain treatment (6). The pain prevents patients from carrying out normal daily activities and influences appetite, mood, self-esteem, relationships with others and mobility. In some countries it is seen that untreated pain leads to a desire for death, euthanasia or assisted suicide (4). Pain relief improves the quality of life (7). Unfortunately, cancer pain is often not treated or is treated inadequately. The WHO have demonstrated that most, if not all, cases of cancer pain, could be treated successfully, if existing medical knowledge and suitable therapies were put into practice. There exists a lacuna in the treatment that is represented by the difference between what could be done and what is actually done in the fight against cancer pain. Training, informing health workers and facilitating access to analgesic treatments and palliative care can close this gap (5). The WHO Expert Committee on Cancer Pain Relief and Active Supportive Care (8), stated in 1990 that "freedom from pain should be considered a right of every cancer patient and access to pain therapy as a measure of respect for this right". In 1986, the World Health Organization, in an effort to optimize cancer pain therapy, suggested a simple three point analgesic ladder (figure 1) for the use of opioids for the treatment of cancer pain (6). Although adoption of the therapies suggested by this analgesic ladder improves pain management in the majority of patients, it is estimated that from 5% to 15% of patients with cancer pain are unable to adequately control their pain, following these guidelines (9-11). In addition there are pains classified as "breakthrough pains" (12) which are difficult to manage www.intechopen.com Intrathecal Drug Administration for the Treatment of Cancer and Non-Cancer Chronic Pain 113 and contain, both because they are unpredictable and because there is a lack of suitable drugs. In order to tackle this need, new drug formulations have been developed such as immediate release morphine, transmucosal fentanyl (13) and indications for invasive treatments with analgesic infusion in the liquor.

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“…[18][19][20] Some authors mention that lysis of epidural adhesions may be a therapeutic option, 2,21 but there is no consensus. 22 Treatment with spinal cord stimulation 23,24 and intrathecal drug delivery 25,26 produce good results, but these are procedures that involve high cost and limited availability. Nevertheless, compared with the costs related to hospital stay and reoperation, these procedures may actually cost less and provide better long-term results.…”

Section: Introductionmentioning

confidence: 99%