Efficacy and Technical Complications of Long-Term Continuous Intraspinal Infusions of Opioid and/or Bupivacaine in Refractory Nonmalignant Pain: A Comparison Between the Epidural and the Intrathecal Approach with Externalized or Implanted Catheters and Infusion Pumps

Dahm, Peter; Nitescu, Petre; Appelgren, L.; Curelaru, I

doi:10.1097/00002508-199803000-00003

Cited by 96 publications

(36 citation statements)

References 33 publications

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“…The major complications of the intrathecal narcotics pump observed in 3 patients (23.1%) were central nervous system infection requiring pump removal, cerebrospinal fluid leak requiring laminectomy and perispinal abscess with bacterial meningitis requiring pump removal. This study shows a good efficacy of the intrathecal narcotics pump in chronic pancreatitis patients with persistent pain; however, as previously reported [92], the risk of this therapeutic modality is high. Furthermore, we need longer follow-ups and especially therapeutic trials comparing pancreatectomy, the intrathecal narcotics pump and implanted nerve stimulators.…”

Section: A New Perspective For the Treatment Of Intractable Pain In Csupporting

confidence: 69%

Alcoholic Pancreatitis: Pathogenesis, Incidence and Treatment with Special Reference to the Associated Pain

Pezzilli

Morselli-Labate²

2009

IJERPH

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Alcoholic pancreatitis continues to stir up controversy. One of the most debated points is whether from onset it is a chronic disease or whether it progresses to a chronic form after repeated episodes of acute pancreatitis. Histological studies on patients with alcoholic pancreatitis have shown that the disease is chronic from onset and that alcoholic acute pancreatitis occurs in a pancreas already damaged by chronic lesions. Genetic factors may also play a role in the pathogenesis of alcoholic disease. The incidence of chronic alcoholic pancreatitis seems to have decreased in the last twenty years. Finally, recent therapeutic studies which have shown medical or surgical approaches capable of reducing the pain episodes in chronic pancreatitis patients will be described.

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Section: A New Perspective For the Treatment Of Intractable Pain In Csupporting

confidence: 69%

Alcoholic Pancreatitis: Pathogenesis, Incidence and Treatment with Special Reference to the Associated Pain

Pezzilli

Morselli-Labate²

2009

IJERPH

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“…In Sweden, the infusion of a combination of morphine and bupivacaine via an externalized catheter has been studied extensively by a group in Gothenburg, both for cancer pain [172,219,220] and non-cancer pain [62,171]. Bupivacaine can also be used as the sole agent for ITA [61,67,142].…”

Section: Intrathecal Analgesia In Cancer Painmentioning

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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“…[54][55][56] Adverse effects of bupivacaine are usually dose related and include paresthesia, motor and sensory blockade, arterial hypotension, diarrhea, and urinary retention. 53,57,58 These adverse effects have been associated with daily bupivacaine hydrochloride doses exceeding 45 mg in 24 hours. [57][58][59] The use of other local anesthetics for long-term continuous intrathecal administration is limited due to insufficient safety and efficacy information.…”

Section: 24 Commonmentioning

confidence: 99%

“…53,57,58 These adverse effects have been associated with daily bupivacaine hydrochloride doses exceeding 45 mg in 24 hours. [57][58][59] The use of other local anesthetics for long-term continuous intrathecal administration is limited due to insufficient safety and efficacy information. Currently, ropivacaine does not have FDA-approved labeling for intrathecal administration.…”

Section: 24 Commonmentioning

confidence: 99%

Intrathecal drug therapy for long-term pain management

Ghafoor

Epshteyn²,

Carlson

et al. 2007

American Journal of Health-System Pharmacy

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The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.

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Efficacy and Technical Complications of Long-Term Continuous Intraspinal Infusions of Opioid and/or Bupivacaine in Refractory Nonmalignant Pain: A Comparison Between the Epidural and the Intrathecal Approach with Externalized or Implanted Catheters and Infusion Pumps

Cited by 96 publications

References 33 publications

Alcoholic Pancreatitis: Pathogenesis, Incidence and Treatment with Special Reference to the Associated Pain

Alcoholic Pancreatitis: Pathogenesis, Incidence and Treatment with Special Reference to the Associated Pain

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

Intrathecal drug therapy for long-term pain management

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