Treatment of intractable cancer pain by electronically controlled parenteral infusion of analgesic drugs

Hl, Shaw

doi:10.1002/1097-0142(19931201)72:11+<3416::aid-cncr2820721607>3.0.co;2-h

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…Many of these systems deliver medications systemically, e.g., as continuous infusion for anesthesia (10) or analgesia (11). A closed-loop feedback system for insulin infusion is in use for diabetes, also with peripheral injection of medication.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical literature on drug delivery systems and use of infusion devices to deliver medications for a variety of human disorders is substantial. Many of these systems deliver medications systemically, e.g., as continuous infusion for anesthesia (10) or analgesia (11). A closed-loop feedback system for insulin infusion is in use for diabetes, also with peripheral injection of medication.…”

Section: Discussionmentioning

confidence: 99%

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Local Perfusion of Diazepam Attenuates Interictal and Ictal Events in the Bicuculline Model of Epilepsy in Rats

1997

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Summary: Purpose:We evaluated the efficacy of local perfusion of diazepam (DZP) in suppression of EEG spikes and behavioral seizures produced by bicuculline methiodide (BMI) applied to rat sensory motor cortex and hippocampus.Methods: Data were obtained from 37 rats implanted with EEG head plugs and perfusion cannulas. BMI 4 mM, 5 pl was infused on neocortex through the epidural space in 23 rats. BMI 0.1 mM, 2 p1 was infused into the left hippocampus in 14 rats.Results: DZP 0.75-1.0 mg markedly reduced the spiking to a level of 9.9 t 15.8% of baseline for DZP as compared with 90.2 t 57.9% of baseline for vehicle-treated rats. DZP reduced spiking in a hippocampal BMI focus to 1.9 k 2.4% of baseline spiking, as compared with 98.0 & 95.6% of that in vehicle-treated animals. The amount of spread of solution was estimated with methylene blue (MB) injections. Ictal events also were attenuated. In most of the animals, systemic levels of DZP were unmeasurable and injection on the contralateral side did not reduce spiking.Conclusions: These findings suggest that focal application of antiepileptic drugs (AEDs) in brain may be a useful new avenue for therapy of intractable partial seizures. Key Words: Seizures-Epilepsy-Electrophysiology-DiazePam-Bicuculline-Drug delivery systems.The mainstay of therapy for epilepsy remains systemic administration of antiepileptic drugs (AEDs). Approximately 25-30% of people with epilepsy are unresponsive to or intolerant of systemic medications (1). Some of these patients can be helped by surgical removal of the seizure focus (2), most commonly an anterior mesial temporal seizure lobe focus. Nevertheless, some individuals with intractable partial (focal) seizures in critical areas of the brain or in more than one location are not candidates for surgery. These patients experience ongoing partial or secondarily generalized seizures. New methods of treating such patients are required.We used white rats to study the local perfusion of diazepam (DZP) directly on brain tissue to stop focal seizures. These studies in an animal model system can serve as a first step toward examining the feasibility of a local perfusion system for epilepsy in humans. Preliminary reports of our findings were published in abstract form (3). METHODSRandomized, double-blinded data were obtained from 37 male Sprague-Dawley white rats weighing 250-500 g obtained from the Charles River breeding colony. In the first stage of the experiment, bone screws and cannulas were implanted in the rats. Each rat was anesthetized with ketamine 40 mg/kg, xylazine 5.5 mg/kg, and acepromazine maleate 0.8 mg/kg by intramuscular injection in -0.2-ml vol.While under anesthesia, rats were placed in a head holder with atraumatic ear bars, and the cranium was exposed through a longitudinal incision. Bone screws (Small Parts, Coral Gables, FL, U.S.A.) were implanted in the left and right frontal bones and the middle and posterior left and right parietal bones and overlying the midline sinus as a reference. A wire was inserted in neck muscle as...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Local Perfusion of Diazepam Attenuates Interictal and Ictal Events in the Bicuculline Model of Epilepsy in Rats

1997

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“…A study of 85 palliative care cancer patients found that the intensity of incident pain may be reduced by increasing the total opioid dose above the prescription required for pain at rest (Mercadante et al , 2004). A major increase in basal dose aimed at reducing incident pain may however result in unacceptable side effects, particularly sedation (Shaw, 1993; Mercadante et al , 2004). The prescription of a CNS stimulant (e.g.…”

Section: Pharmacological Measures To Reduce Pain Perceptionmentioning

confidence: 99%

“…Health care professionals can utilize the therapeutic relationship to assist patients with their ‘human’ response to their cancer and their pain (Taylor, 1988; Thorne et al , 2005; Liu and Fawcett, 2008). The ability of an individual to cope with pain is related to how one perceives the pain, the meaning they attribute to it and the level of fear it invokes (Shaw, 1993; Taylor, 1988; Payne, 2000). A common fear for cancer patients is that of a painful death (Miller and Massie, 2006).…”

Section: Therapeutic Relationshipmentioning

confidence: 99%

Prostate cancer with bone metastasis: an overview of pain assessment and management

Osborne

2008

Int J of Uro Nursing

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The challenges of assessing and assisting men with chronic progressive metastatic bone pain secondary to prostate cancer can be immense. All patients have a right to have their pain assessed and relieved by knowledgeable health professionals, yet many urology outpatient clinic nurses come from a surgical background and have limited skills and knowledge in this area. This article aims to enhance the knowledge of urology nurses, by critically analysing and discussing components of current pain management practice, for men with painful bone metastasis. To this end, the pathophysiology of metastatic bone pain is briefly outlined followed by pain definitions from literature and information pertaining to assessment of bone pain. Barriers to effective pain assessment are identified, along with a brief discussion on the impact of factors like fatigue, anxiety and depression on pain. A review is undertaken of selected pharmacological and non-pharmacological strategies for the management of bone pain, as reported in published literature. Knowledge of the WHO analgesic ladder for cancer pain and the actions of pain-relieving medications and their adjuncts will better equip nurses to educate patients regarding their effective use. Insights gained into potentially effective non-pharmacological strategies for the reduction of the experience of pain should prompt nurses to investigate what modalities are on offer at their place of work and within their local community. Written resources can then be created to share this information with patients if they are not already in existence.

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“…administration include phlebitis, noscomial infection and cost, for it usually requires hospitalisation, although the development of portable ambulatory infusion pumps has made this technique adaptable to the home health care setting in appropriately selected patients [34].…”

Section: Intravenous Administrationmentioning

confidence: 99%

Problems with opiates in cancer pain: parenteral opioids

Glare¹

1997

Support Care Cancer

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Morphine is the preferred drug for the management of moderate-severe chronic cancer pain. The best route of administration is by mouth, because it is simple, safe, convenient, inexpensive and effective. Non-oral modes of administration should be only considered if (a) the oral route becomes unavailable or (b) there is documentation of failure of maximal doses of oral morphine and coanalgesic drugs. Recent developments have made new routes of morphine administration fashionable--in the absence of supportive pharmacokinetic or pharmacodynamic data--even when departure from established practice is not justified. It is important for clinicians to be familiar with the practicalities and problems that limit the utility of the non-oral routes, and the state of current understanding of these options will be reviewed.

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Treatment of intractable cancer pain by electronically controlled parenteral infusion of analgesic drugs

Cited by 7 publications

References 30 publications

Local Perfusion of Diazepam Attenuates Interictal and Ictal Events in the Bicuculline Model of Epilepsy in Rats

Local Perfusion of Diazepam Attenuates Interictal and Ictal Events in the Bicuculline Model of Epilepsy in Rats

Prostate cancer with bone metastasis: an overview of pain assessment and management

Problems with opiates in cancer pain: parenteral opioids

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