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Sensory nerve fibers that contain calcitonin gene-related peptide (CGRP) have been shown previously to sprout into inflamed tissue surrounding sites of pulpal injury. The sprouting fibers contain increased CGRP immunoreactivity (IR), and neuropeptide levels increase in the surrounding pulp. We compared denervated and innervated first mandibular molars of rats to determine whether the absence of sensory nerve fibers affected tissue survival and healing after pulp exposure. Significant differences were seen between innervated and denervated teeth six days after occlusal exposure, with more extensive necrosis in the denervated teeth, and less survival of vascular pulp. When exposures were on the side of the crown, there was no significant difference between the innervated and denervated teeth. Both the innervated and denervated teeth had begun to make reparative dentin and osteodentin by six days after tooth injury. This study shows that teeth with sensory denervation had an accelerated loss of pulp tissue following occlusal exposure compared with innervated teeth with similar injury.

The INFUSAID model #400 totally implantable drug delivery system was implanted in 17 patients for the continuous infusion of spinally administered preservative-free morphine sulfate. Sixteen patients had pain of malignant origin, and one patient had pain secondary to meningomyelocele. Over time, there was a consistent mean improvement in analgesia scores ranging from 50% to 70% of the control levels for 16 of the patients with cancer-related pain. This form of pain therapy was not successful in treating the benign pain of the patient with meningomyelocele. Overall, the patients with cancer were pleased with their pain therapy, experienced few complications, and reported improved quality of life. Continuous infusion of spinally administered narcotics using a totally implantable drug delivery system such as the INFUSAID model #400 is a safe, complication-free procedure for the control of cancerrelated pain.Cancer 56:696-702, 1985.MALL DOSES OF spinally administered narcotics S (SAN), when injected peridurally or intrathecally, produce profound analgesia. This analgesic effect of exogenous SAN results from opiate blocking of enkephalinergic receptors in the substantia gelatinosa of the spinal cord. The presence of opiate receptors on cell membranes in the brain and spinal cord of vertebrate animals has been studied by severalOther investigators have described endogenous opioid-like peptides which also act at these These peptides-endorphins and enkephalins alike-modulate the reception of nociceptive information. Metenkephalin, an endogenous peptide, is released by axons of the descending modulation pathways in the substantia gelatinosa of the spinal cord in response to afferant painful inputs to rostra1 brain centers. This opioid-like peptide binds to opiate receptors of postsynaptic interneurons and prevents the reception of "substance P," an excitatory protein necessary for the transmission of noxious information released by adelta and c-fiber afferants. By substituting long-acting SAN for metenkephalin, (which has a halflife in the millisecond range) prolonged and profound

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