Plasma morphine and morphine-6-glucuronide during chronic morphine therapy for cancer pain: plasma profiles, steady-state concentrations and the consequences of renal failure

Pain ◽  
1991 ◽  
Vol 47 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Russell K. Portenoy ◽  
Kathleen M. Foley ◽  
James Stulman ◽  
Elizabeth Khan ◽  
Jean Adelhardt ◽  
...  
1992 ◽  
Vol 36 (4) ◽  
pp. 250???251
Author(s):  
R. K. PORTENOY ◽  
K. M. FOLEY ◽  
J. STULMAN ◽  
E. KHAN ◽  
J. ADELHARDT ◽  
...  

Neurology ◽  
1991 ◽  
Vol 41 (9) ◽  
pp. 1457-1457 ◽  
Author(s):  
R. K. Portenoy ◽  
E. Khan ◽  
M. Layman ◽  
J. Lapin ◽  
M. G. Malkin ◽  
...  

1992 ◽  
Vol 36 (4) ◽  
pp. 251
Author(s):  
R. K. PORTENOY ◽  
K. M. FOLEY ◽  
J. STULMAN ◽  
E. KHAN ◽  
J. ADELHARDT ◽  
...  

1989 ◽  
Vol 37 (2) ◽  
pp. 185-189 ◽  
Author(s):  
L. v. Bortel ◽  
R. Böhm ◽  
J. Mooij ◽  
P. Schiffers ◽  
K. H. Rahn

1989 ◽  
Vol 13 ◽  
pp. S52-S54 ◽  
Author(s):  
H. Schunkert ◽  
J. Kindler ◽  
M. Gassmann ◽  
W. Lahn ◽  
R. Irmisch ◽  
...  

1987 ◽  
Vol 21 (12) ◽  
pp. 981-985
Author(s):  
Marc L. Citron ◽  
John R. Reynolds ◽  
Wen-Nuei Lin ◽  
Peter D. Frade ◽  
Mark Schemansky ◽  
...  

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15–275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of ≤ 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.


2002 ◽  
Vol 58 (5) ◽  
pp. 353-356 ◽  
Author(s):  
Monica Holthe ◽  
Pål Klepstad ◽  
Kolbjørn Zahlsen ◽  
Petter Borchgrevink ◽  
Lars Hagen ◽  
...  

2022 ◽  
Author(s):  
Jianlong Bu ◽  
Wu Xiaohong ◽  
Deng Lin ◽  
Ma Chao ◽  
Shi Xiaoding ◽  
...  

Abstract The pro-inflammatory (M1) and anti-inflammatory (M2) status of microglial determines the outcome of neuroinflammation, which contributes to the pathogenesis of chronic morphine tolerance. Studies report that α2-adrenoceptor agonist dexmedetomidine exerts anti-inflammatory effects in inhibiting morphine tolerance in normal and neuropathic pain animals, which has not been studied in cancer pain. Therefore, we investigate the effect of intrathecal DEX on morphine tolerance in cancer pain, and whether dexmedetomidine functions via modulating microglial activation and M1/M2 polarization. 54 Wistar rats with intrathecal catheterization were treated by morphine for 10 days. Test groups received intrathecal α2-adrenoceptor agonist dexmedetomidine or antagonist MK-467. The mRNA levels of TLR4 and NF-κB were tested by RT-PCR. The protein levels of TLR4, NF-κB, Iba-1, iNOS, CD206 were quantifed using Western blotting, and IL-10 and TNF-α were examined by ELISA. Dexmedetomidine attenuates mechanical threshold and thermal latency, and increased the expression of TLR4 and NF-κB in morphine tolerance of cancer pain. Dexmedetomidine attenuates mechanical and thermal nociception in morphine tolerance in cancer pain rats. Intrathecal DEX pre-treatment significantly increased the protein levels of microglia maker Iba-1, M2 marker CD206 and anti-inflammatory factor IL-10, while had no evident influence on the pro-inflammatory factor TNF-α and M1 marker iNOS in morphine tolerance. Our findings suggest that intrathecal dexmedetomidine attenuates morphine tolerance in cancer pain via α2-adrenoceptor pathway. Furthermore, dexmedetomidine upregulates TLR4/NF-κB pathway and induces microglia activation in chronic morphine tolerance of cancer pain. The anti-inflammatory effect of dexmedetomidine might be exerted by inducing microglia M2 polarization and increasing anti-inflammatory factor IL-10.


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