STUDY OF TITRATION OF INTRATHECAL MORPHINE IN CANCER PATIENTS WITH INTRACTABLE PAIN, REFRACTORY TO SYSTEMIC OPIOIDS: WHAT RATIOS FOR WHICH PATIENTS?

2017 ◽  
Author(s):  
Damien Leblanc
Keyword(s):  
Cancer Patients ◽  
Intrathecal Morphine ◽  
Intractable Pain

Intrathecal and intraventricular morphine for pain in cancer patients: initial study

1982 ◽  
Vol 56 (2) ◽  
pp. 241-245 ◽  
Author(s):  
Milam E. Leavens ◽  
C. Stratton Hill ◽  
David A. Cech ◽  
Jane B. Weyland ◽  
Jaye S. Weston
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Cancer Patients ◽  
Intrathecal Morphine ◽  
Initial Study ◽  
Intractable Pain ◽  
Content Type ◽  
Fine Print

✓ Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

Intrathecal drug delivery versus comprehensive medical management as it may impact inpatient length of stay, readmission, and inpatient cost of care

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18520-18520
Author(s):  
J. D. Isaacs ◽  
L. J. Stearns ◽  
W. H. Poling ◽  
D. Milton ◽  
J. Nasternak ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Intensive Care ◽  
Cancer Patients ◽  
Medical Management ◽  
Group Versus ◽  
Cost Of Care ◽  
Inpatient Cost ◽  
Intractable Pain ◽  
The Mean ◽  
Intractable Cancer Pain

18520 Background: Long lengths of stay (LOS) and high readmission rates partly explain the high medical costs of treating cancer patients. Uncontrolled pain is the number two reason for hospital readmission. Aggressive measures and treatment strategies for relieving intractable cancer pain can require the implantation and management of intrathecal (IT) drug delivery systems. The objective was to examine LOS, episodes of readmission, intensive care (ICU) stays, and discharge status among patients treated with IT versus comprehensive medical management (CMM) for pain. Methods: Retrospective case-control medical record review methods were employed. Sixty-three randomly selected cancer patients who received an IT were matched on gender, age group, and primary diagnosis to 63 who did not. Results: The total LOS for the 63 non-IT patients was 567 days. The total LOS for the 63 IT patients was 301 days. The mean LOS among the non-IT patients was 9 days. The mean LOS among the IT patients was 4.7 days. Total LOS for the non-IT patients was statistically significantly higher. Among the 63 non-IT patients 94 total inpatient episodes were experienced. Among the 63 IT patients 68 total inpatient episodes were experienced. The likelihood of a non-IT patient readmitting was nine-fold higher than the IT patients and statistically significantly different. The total Intensive Care Unit (ICU) days for the 63 non-IT patients were 60 days. The total ICU days for the 63 IT patients were 30 days. The total ICU for the non-IT patients was not statistically significantly higher. The likelihood of a non-IT patient expiring while an inpatient was fourteen-fold higher than the IT patients and was statistically significantly different. The average cost per episode was 22% higher among the IT group versus the non-IT group. Conclusions: The implantable IT system for pain management among cancer patients experiencing intractable pain may be a significant influence on patient LOS, readmission, and ICU episodes even though it represents a 22% increase in average inpatient costs per episode. Controlled studies examining these hospital indicators as primary outcomes for these patients by evaluating the IT drug delivery system as compared to CMM are warranted. No significant financial relationships to disclose.

Preliminary results from a phase I study of substance P-saporin in terminal cancer patients with intractable pain.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 191-191 ◽  
Author(s):  
Arthur E. Frankel ◽  
Hugh Nymeyer ◽  
Douglas A. Lappi ◽  
Denise Higgins ◽  
Chul Ahn ◽  
...  
Keyword(s):  
Substance P ◽  
Phase I ◽  
Cancer Patients ◽  
Phase I Study ◽  
Intrathecal Injection ◽  
Thermal Hyperalgesia ◽  
Single Subject ◽  
Intractable Pain ◽  
Lumbar Region ◽  
Cardiac Abnormalities

191 Background: For 10-15% of cancer patients, pain cannot be controlled using existing therapies (Zech et al., Pain, 63, 65-76, 1995). SP-SAP is the first targeted toxin to undergo phase I testing for pain. SP-SAP (Wiley and Lappi, Neurosci Lett, 230, 97-100, 1997) covalently linkes substance P (SP), a neuromodulator that binds to NK1 receptors on laminae I and X of the dorsal horn, and saporin (SAP), a ribosomal toxin that ablates cells that express NK1 and endocytose the toxin. Intrathecal injections of SP-SAP in rats reduce chemically or thermally induced pain, thermal hyperalgesia, and mechanical allodynia, with no signs of motor, sensory, or behavioral dysfunction (Mantyh et al., Science, 278, 275-9, 1997; Nichols et al., Science, 286, 1558-61, 1999; Suzuki et al., Nature Neurosci, 5, 139-26, 2002; Vierck et al., Neurosci, 199, 223-32, 2003). In canines, intrathecal injections into the lumbar region – 45 mcg for 10-15 kg (Allen et al., Toxicol Sci, 91, 286-98, 2006) or 15 mcg for 8-12 kg (Wiese et al., Anesthesiol, 119, 1163-77, 2013) – produce no neurological, behavioral, or histological deficits. A double-blinded RCT of SP-SAP for the treatment of bone pain in canines (Brown and Agnello, Anesthesiol, 199, 1178-85, 2013) showed that a single injection of 60 mcg (above 30 kg) or 40 mcg (below 30 kg) significantly reduced pain as measured by time to owner unblinding (p=0.002) or number of canines unblended (p=0.001). Methods: A single intrathecal injection of SP-SAP is made at the L5-S1 interspace of cancer patients with intractable sub-umbilical pain. Single subject cohorts are at doses of 1, 2, 4, 8, 16, 32, 64, and 90 mcg. Primary outcomes are assessed by pain survey (VAS “bothersome pain”, VAS “pain intensity”, ODI, EQ-5D, and BDI) and medication use log. Patients are monitored for toxicity, neurological and cardiac abnormalities, and SP-SAP antibodies for 6 months. Results: This report presents the results from the first three subjects of the phase I study. No evidence of toxicity or neurological or cardiac abnormalities were found. No clear evidence for pain reduction was observed. Conclusions: At existing doses (< 4 mcg), SP-SAP appears safe for human use. The study is continuing with dose escalation. Clinical trial information: NCT02036281.

Clearance of Continuous Intravenous Morphine for Severe Cancer Pain

1987 ◽  
Vol 21 (12) ◽  
pp. 981-985
Author(s):  
Marc L. Citron ◽  
John R. Reynolds ◽  
Wen-Nuei Lin ◽  
Peter D. Frade ◽  
Mark Schemansky ◽  
...  
Keyword(s):  
Steady State ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Intractable Pain ◽  
Time Period ◽  
Elimination Half ◽  
Steady State Serum ◽  
Intravenous Morphine ◽  
High Doses ◽  
Time Required

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.

Intrathecal Morphine in Cancer Patients Tolerant to Systemic Opiates

1982 ◽  
pp. 138-140 ◽  
Author(s):  
A. Tung ◽  
R. Tenicela ◽  
G. Barr ◽  
P. Winter
Keyword(s):  
Cancer Patients ◽  
Intrathecal Morphine

Effect of Morphine and Bupivacaine on Nicotine-Induced Catecholamine Secretion from Encapsulated Chromaffin Cells

2005 ◽  
Vol 277-279 ◽  
pp. 56-61
Author(s):  
Hai Yan Hong ◽  
Jeong Ok Lim ◽  
Woon Yi Baek
Keyword(s):  
High Performance Liquid Chromatography ◽  
Liquid Chromatography ◽  
Cancer Patients ◽  
Chromaffin Cells ◽  
High Performance ◽  
Hplc Analysis ◽  
Intractable Pain ◽  
Analgesic Effects ◽  
Bovine Chromaffin Cells ◽  
Analysis System

The control of intractable pain through transplanted of chromaffin cells has been recently reported where the analgesic effects are principally due to the production of opioid peptides and catecholamines (CAs) by the chromaffin cells. Currently many cancer patients receive general opioids or local anesthetics, such as bupivacaine. Therefore, the present study investigated the effect of morphine or bupivacaine on the secretion of nicotine-induced CAs from encapsulated chromaffin cells over a period of 180 min. As such, bovine chromaffin cells were isolated and encapsulated with alginate–poly–L–lysine–alginate (APA) biomaterials to prevent immunorejection. The capsules were then pre-incubated with nicotine for 5 min prior to morphine or bupivacaine stimulation, and the quantity of CAs analyzed using a high performance liquid chromatography (HPLC) analysis system. The resulting data showed that the encapsulated chromaffin cells retained the ability of their parent chromaffin cells when responding to opioids by suppressing the release of CAs. In contrast, bupivacaine did not have any statistically significant affect on the basal and nicotine-induced CA release from the encapsulated chromaffin cells.

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