Use of Intrathecal and Epidural Morphine for Pain Relief in Patients With Malignant Diseases: A Preliminary Report

Rico, Rodolfo; Hobika, G. H.; Avellanosa, Anthony M.; Trudnowski, R. J.; Rempel, J; West, Charles R.

doi:10.1016/s0022-5347(17)52148-5

Cited by 5 publications

(6 citation statements)

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“…Routes of spinal administration were intrathecal in 10 studies, 23,28,32,35 – 38,41 – 43 epidural in 11 studies, 21,22,24,30,31,33,34,39,40,44,45 and mixed intrathecal and epidural in seven studies. 2,25 – 27,29,46,47…”

Section: Resultsmentioning

confidence: 99%

“…In total, 26 studies described improved pain relief after initiating spinal opioid therapy. 2,21 – 39,41 – 46 Two studies compared effects according to type of pain and spinal techniques; superior effects of epidural morphine were observed in somatic pain 40 and intrathecal were superior to epidural opioids. 47 In 23 studies several side effects were reported on spinal opioids; however, in four studies side effects were not reported 32,36,39,47 and in one study no side effects were observed.…”

Section: Resultsmentioning

confidence: 99%

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Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

2011

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

2011

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“…Soon, the use of intrathecal morphine injections in humans was described [253]. These ground-breaking studies were followed by others [89,134,203], and in 1981 Onofrio & Yaksh published the first case report of a continuous intrathecal infusion of morphine [177]. Hence, intrathecal analgesia (ITA) has been practised for over three decades.…”

Section: Intrathecal Analgesiamentioning

confidence: 99%

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Bäckryd¹

2015

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The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain. In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question. In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor. In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses

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“…The human application was promoted by the fact that direct IT morphine offered greater control of drug levels and rapid reversibility, produced fewer side effects, and offered superior pain control for certain refractory pain types. 4 In the early 1980s, Rico et al 5 and Leavens et al 6 both reported satisfactory analgesic effects with minimal side effects in patients treated with boluses of IT morphine. Both groups reported moderate to significant pain relief in a majority of the cancer patients studied (Rico et al, 78%; Leavens et al, and 66%), using individual IT injections of morphine.…”

Section: Intrathecal Pain Managementmentioning

confidence: 99%

Intrathecal Pumps

2008

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Summary: Direct neuroaxis drug delivery has expanded the physician's armamentarium to provide treatment options to those who have failed more conservative interventions. Starting from Bier's 'cocainization of the spinal cord' in 1898, direct nervous system pharmacy delivery has long been recognized as an effective means to treat pain. Intrathecal pump systems are now commonplace in the management of numerous pain states, as well as of neuromuscular sequelae of central nervous system injury. There has been much advancement in the physiologic and pharmacologic understanding of direct neuromodulation, providing a growing number of treatment options depending on the specific disease state. As well, surgical techniques and catheter systems have undergone refinements providing improved long-term safety and efficacy. We present a review of the historical evolution to current intrathecal therapies, as well as a dialog regarding patient selection, drug options, and side effects. Also, included is a discussion of surgical techniques, current delivery options and complications concerning pump placement.

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Use of Intrathecal and Epidural Morphine for Pain Relief in Patients With Malignant Diseases: A Preliminary Report

Cited by 5 publications

References 0 publications

Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Intrathecal Pumps

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