Continuous Subcutaneous Infusion of Ketorolac in Cancer Neuropathic Pain Unresponsive to Opioid and Adjuvant Drugs. A Case Report

1996 ◽  
Vol 82 (4) ◽  
pp. 413-415 ◽  
Author(s):  
Carla Ripamonti ◽  
Chiara Ticozzi ◽  
Ernesto Zecca ◽  
Carlos H. Rodriguez ◽  
Franco De Conno
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Side Effects ◽  
Cancer Patient ◽  
Cancer Pain ◽  
Antidepressant Drugs ◽  
Analgesic Efficacy ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion ◽  
Nonopioid Analgesic

Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.

Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study

Pain ◽  
1993 ◽  
Vol 53 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Marie-Claude Vanier ◽  
Gaston Labrecque ◽  
Dolorès Lepage-Savary ◽  
Éric Poulin ◽  
Louise Provencher ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cancer Pain ◽  
Subcutaneous Infusion ◽  
Basal Rate ◽  
Continuous Subcutaneous Infusion

A hybrid for pain, i.e. bifunctional analgesics in neuropathy

Ból ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 17-24
Author(s):  
Joanna Starnowska-Sokół
Keyword(s):  
Neuropathic Pain ◽  
Side Effects ◽  
Pain Therapy ◽  
Analgesic Efficacy ◽  
Hybrid Structure ◽  
Multimodal Approach ◽  
Pharmacological Profile ◽  
Hybrid Compounds ◽  
Therapeutic Outcomes ◽  
Promising Perspective

The need of developing new neuropathic pain therapies results from limited potency of currently available treatments, which is underlain by low efficacy of conventional analgesics, complex etiology and pathogenesis of neuropathy, diversity of its symptoms, as well as heightened side effects risk that accompanies the polypharmaceutical strategy, employed commonly to improve the therapeutic outcomes. Designing hybrid compounds, i.e. multimodal molecules that present the affinity to more than one receptor target, offers a promising perspective in this context. The multimodal approach allows to increase the analgesic efficacy of a given compound thanks to aiming at the very pathomechanisms specific for neuropathic pain, and to optimize the pharmacological profile of the drug. Thanks to the hybrid structure, analgesic properties of its moieties can be maximized, even if their action as separate pharmacophores tends to be limited or inconsistent under nerve injury conditions, such as in the case of opioid agonists. The present review discusses selected targets of hybrid compounds in the view of potential neuropathic pain therapy, along with the gains, limitations and challenges related to the use of hybrid compounds.

Antidepressants in Cancer Pain

1991 ◽  
Vol 7 (4) ◽  
pp. 42-44 ◽  
Author(s):  
Alberto E. Panerai ◽  
Mauro Bianchi ◽  
Paola Sacerdote ◽  
Carla Ripamonti ◽  
Vittorio Ventafridda ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cancer Pain ◽  
Beneficial Effect ◽  
Nerve Injury ◽  
Analgesic Effect ◽  
Tricyclic Antidepressants ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Morphine Analgesia

Studies conducted in recent years have helped define the role of antidepressant drugs in the management of cancer pain. The anti-nociceptive action of these agents seems to be independent of beneficial effect on depression or mood. Among antidepressant drugs, those of the tricyclic class are preferred when an analgesic effect is sought. Their primary application is for pain due to nerve injury, so-called “neuropathic pain”. Although the co-administration of tricyclic antidepressants may increase plasma morphine concentrations, any potentiation of morphine analgesia is thought not to be due to an increased bioavailability of the opiate, but to an intrinsic analgesic effect of antidepressants. On this basis, the use of antidepressants in combination with opioids for the treatment of cancer pain is suitable when a component of deafferentation is present or when there is concomitant depressive illness.

scholarly journals Oral controlled-release morphine sulfate. Analgesic efficacy and side effects of a 100-mg tablet in cancer pain patients

Cancer ◽  
1989 ◽  
Vol 63 (11) ◽  
pp. 2284-2288 ◽  
Author(s):  
Russell K. Portenoy ◽  
Mathelyn Maldonado ◽  
Ronald Fitzmartin ◽  
Robert F. Kaiko ◽  
Ronald Kanner
Keyword(s):  
Controlled Release ◽  
Side Effects ◽  
Cancer Pain ◽  
Analgesic Efficacy ◽  
Morphine Sulfate ◽  
Pain Patients

Continuous Subcutaneous Infusion of Buprenorphine for Cancer Pain Control

1989 ◽  
Vol 5 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Junko Noda ◽  
Shinichiro Umeda ◽  
Toshiyuki Arai ◽  
Akihiro Harima ◽  
Kenjiro Mori
Keyword(s):  
Cancer Pain ◽  
Pain Control ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion

scholarly journals Analgesic efficacy of nefopam for cancer pain: a randomized controlled study

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 378
Author(s):  
Koravee Pasutharnchat ◽  
Wichita Wichachai ◽  
Rungrawan Buachai
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Cancer Pain ◽  
Breakthrough Pain ◽  
Analgesic Efficacy ◽  
Pain Reduction ◽  
Morphine Consumption ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Pain

Background: Nefopam is a non-opioid, non-steroidal, central acting drug used effectively for postoperative pain. The efficacy of nefopam for cancer pain remains unclear. We aimed to evaluate the analgesic efficacy of nefopam for cancer pain in a randomized controlled trial. Methods: Patients with moderate to severe cancer pain (n=40) were randomly divided into two groups. The nefopam group (n=20) received three 20 mg doses of nefopam every 8 hours. The placebo group (n=20) received normal saline. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain for 48 hours. The primary outcome was significant pain reduction. Secondary outcomes were morphine consumption over 48 hours and incidence of side effects. Results: The nefopam group showed pain reduction at 12 hours (65% of patients), 24 hours (80%), 36 hours (85%), and 48 hours (65%). The placebo group showed pain reduction at 12 hours (70%), 24 hours (75%), 36 hours (80%), and 48 hours (60%). However, there were no statistically significant differences between the groups (p>0.05). The median dosage of morphine consumption in 48 hours was lower in the nefopam group (25.5 mg) compared with the placebo group (37 mg), but this was not statistically significant (p=0.499). There were no statistically significant differences in blood pressure and heart rate between the groups. Side effects in both groups were comparable. Conclusions: At dosage of 60 mg in 24 hours, nefopam did not provide significant pain reduction in moderate to severe cancer pain patients. However, there was a trend of reduced opioid consumption. Further studies with larger sample sizes, longer duration, or higher doses of nefopam are warranted. Registration: Thai Clinical Trail Registry (TCTR) ID TCTR20181016001; registered on 12 October 2018.

scholarly journals Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E905-E915
Author(s):  
Hélène Staquet
Keyword(s):  
Neuropathic Pain ◽  
Side Effects ◽  
Cancer Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Third Ventricle ◽  
High Dose ◽  
Intractable Pain ◽  
Intracerebroventricular Infusion ◽  
Intractable Cancer Pain

Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/ or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications. Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/dy and up to a median of 1.2 µg/dy [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/dy [0.24; 0.66] up to 0.6 mg/dy [0.45; 4.63] and 1.2 mg/dy [0; 2.4] up to 2.23 mg/dy [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. Key words: Intracerebroventricular infusion, ziconotide, intractable pain, nociceptive and neuropathic pain

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