Observations on Extradural Morphine Analgesia in Various Pain Conditions

Magora, E.; Olshwang, D.; Eimerl, D.; Shorr, J.; Katzenelson, R.; Cotev, Shamay; Davidson, Julian M.

doi:10.1097/00132582-198106000-00018

Cited by 20 publications

(22 citation statements)

References 4 publications

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“…Traditionally, administration of opioids have been shown to induce hypoalgesia and thermal hypoaesthesia without alteration of fine touch and proprioception. 4,16,26 Somewhat challenging this view are the observations of Park et al 31 who showed that the non-noxious perceptual thresholds to high frequency electrical stimulations (250 and 2000 Hz) were decreased following alfentanil administration. On the contrary, there was no change in non-noxious perceptual thresholds when thresholds were measured with low frequency electrical stimulations (5 Hz) and conventional Von Frey hairs.…”

Section: Stimulation Thresholds and Intensitiesmentioning

confidence: 99%

Reduced Analgesic Effect of Acupuncture-like TENS but Not Conventional TENS in Opioid-Treated Patients

Léonard

Cloutier

Marchand

2011

The Journal of Pain

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Acupuncture-like TENS in opioid treated patients 2 AbstractEvidence from recent animal studies indicates that the analgesic effect of low frequency TENS is reduced in opioid tolerant animals. The aim of the present study was to compare the analgesic effect of conventional (high frequency) and acupuncture-like (low frequency) TENS between a group of opioid treated patients and a group of opioid-naive patients in order to determine if this cross-tolerance effect is also present in humans.Twenty-three chronic pain patients (11 who took opioids and 12 who did not) participated in the study. Participants were assigned in a randomized cross-over design to receive alternately conventional and acupuncture-like TENS. There was a significant reduction in pain during and after conventional TENS when compared to baseline for both the opioid and non-opioid group (p<.01). For acupuncture-like TENS however, the analgesic effect of TENS was only observed in the non-opioid group (p<.01), with opioid treated patients showing no change in pain scores during and after TENS when compared to baseline (p>.09). The reduced analgesic effect of acupuncture-like TENS in opioid treated patients is coherent with previous animal studies and suggests that conventional TENS should be preferred in patients taking opioids on a regular basis.Perspective: This study shows that patients taking opioids on a regular basis are less susceptible to benefit from acupuncture-like TENS. This phenomenon is probably attributable to the fact that the analgesia induced by acupuncture-like TENS and opioids are mediated by the same receptors (i.e. μ opioid receptors).

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Section: Stimulation Thresholds and Intensitiesmentioning

confidence: 99%

Reduced Analgesic Effect of Acupuncture-like TENS but Not Conventional TENS in Opioid-Treated Patients

Léonard

Cloutier

Marchand

2011

The Journal of Pain

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“…In man intrathecal or epidural administration of low doses of morphine and pethidine have provided dramatic and long lasting relief of various types of pain (Wang et al, 1979;Behar et al, 1979;Cousins et al, 1979). Relief of labour pains with epidural opiates would provide considerable advantages over conventional epidural analgesia using local anaesthetic agents, but epidural morphine was found to be ineffective for relief of labour pain (Husemeyer et al, 1980;Magora et al, 1980). Epidural pethidine has been reported to provide appreciable pain relief in labour (Perris, 1980) but the effective dosages were considerably greater than the equivalent effective dosages of morphine in non-pregnant patients and the duration of analgesia was also much shorter.…”

Section: Introductionmentioning

confidence: 99%

A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration.

Husemeyer¹,

Cummings²,

Rosankiewicz³

et al. 1982

Brit J Clinical Pharma

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1 Epidural administration of opiates for analgesia has recently generated widespread interest and would theoretically be advantageous as a method for relief of pain in labour. 2 Plasma pethidine concentrations were measured after intravenous, intramuscular and epidural administration of pethidine to women in labour and after epidural administration to non-pregnant female surgical patients. 3 Kinetic parameters were derived from the plasma concentration data in each group of subjects and the relationship between plasma kinetics and analgesia in labour were examined. 4 Absorption of pethidine from the epidural space in pregnant women is rapid and excepting the lower initial values, the average plasma concentration and area under the plasma concentration v time curve did not differ significantly (P < 0.01) from those obtained with intravenous dosage, but were significantly higher (P < 0.01) during the first 2 h after dosage than the results after intramuscular administration. The analgesia provided by the epidural route of administration was greater than with intravenous or intramuscular administration. 5 It is postulated that the analgesic efficacy of epidural pethidine in women in labour is due to a combination of systemic and local effects and that the local effect is attributable to the local anaesthetic properties of pethidine rather than a selective anti-nociceptive action on the spinal cord.

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“…Discussion In this study, extradural administration of Duromorph produced variable effects in patients with malignant and postoperative pain. In this respect, its effects were similar to epidural morphine (2,3). The most satisfactory results were obtained in patients with postoperative pain; although the onset of action was relatively slow (ie 1-2 hours), effective analgesia was produced for 24 hours, and no side-effects were observed.…”

Section: Plasma Morphine Concentrationmentioning

confidence: 65%

“…In these conditions, analgesia is sometimes prolonged (3)(4)(5) and may be partly due to the local action of morphine on neuronal pathways in the substantia gelatinosa (6,7). It is possible that effective analgesia may be further prolonged by the extradural administration of a slow release preparation of morphine, from which the drug can slowly diffuse to its presumed site of action.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Release Extradural Morphine

Howard

Murray

Calvey

et al. 1986

Survey of Anesthesiology

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SummaryThe effects of extradural administration of a microcrystalline preparation of morphine (Duromorph) were studied in 5 patients with postoperative or malignant pain. As assessed by pain scores on a visual analogue scale, the effects of the analgesic were extremely variable; the best results were obtained in patients with postoperative pain. Two patients with chronic pain due to malignant disease developed slow respiratory rates. The plasma concentration of morphine usually followed a biphasic pattern; an initial peak between 0.5 and 1.5 hours was succeeded by a second, large peak between 6 and 12 hours. There was little or no apparent relation between the plasma concentration of morphine and the relief ofpain, suggesting that Duromorph may have a local effect on the spinal cord.

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Observations on Extradural Morphine Analgesia in Various Pain Conditions

Cited by 20 publications

References 4 publications

Reduced Analgesic Effect of Acupuncture-like TENS but Not Conventional TENS in Opioid-Treated Patients

Reduced Analgesic Effect of Acupuncture-like TENS but Not Conventional TENS in Opioid-Treated Patients

A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration.

Prolonged Release Extradural Morphine

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