Hypoalgesia following epidural morphine: a controlled quantitative experimental study

Arendt-Nielsen, Lars; Øberg, B.; Bjerring, Peter

doi:10.1111/j.1399-6576.1991.tb03323.x

Cited by 17 publications

(8 citation statements)

References 22 publications

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“…For heat pain to be sensitive to morphine it has been argued that it needs to be applied with slow temperature rises (<1°C s -1 ) [82,83]. However, morphine has also shown effect on pain from rapid increases in temperature [37,81,[83][84][85].Three studies found sensitivity of electrical pain for morphine, whereas another did not [5,37,53]. Pain evoked by pinching of the skin was sensitive to morphine [5].…”

Section: Figurementioning

confidence: 99%

“…Pain evoked by pinching of the skin was sensitive to morphine [5]. Two studies showed an effect of morphine on the warmth detection threshold and pain detection threshold to heat, pressure and electrical stimulation [37,84,85]. Electrically-induced pain in the teeth and skin has been assessed by electroencephalogram (EEG) recordings.…”

Section: Figurementioning

confidence: 99%

“…However two studies showed an effect of morphine on the warmth detection threshold and pain detection threshold to heat, pressure and electrical stimulation [37,84,85]. Warmth sensations are conveyed by C-fibres and hence there is a neurophysiologic explanation for morphine modulating the sensation of warmth [76].…”

Section: Mechanistic Aspectsmentioning

confidence: 99%

See 2 more Smart Citations

Assessing analgesic actions of opioids by experimental pain models in healthy volunteers – an updated review

Staahl

Olesen

Andresen

et al. 2009

Brit J Clinical Pharma

113

131

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AIMExperimental pain models may help to evaluate the mechanisms of action of analgesics and target the clinical indications for their use. This review addresses how the efficacy of opioids can be assessed in human volunteers using experimental pain models. The drawback with the different study designs is also discussed. METHODA literature search was completed for randomized controlled studies which included human experimental pain models, healthy volunteers and opioids. RESULTSOpioids with a strong affinity for the m-opioid receptor decreased the sensation in a variety of experimental pain modalities, but strong tonic pain was attenuated more than short lasting pain and non-painful sensations. The effects of opioids with weaker affinity for the m-opioid receptor were detected by a more narrow range of pain models, and the assessment methods needed to be more sensitive. CONCLUSIONThe way the pain is induced, assessed and summarized is very important for the sensitivity of the pain models. This review gives an overview of how different opioids perform in experimental pain models. Generally experimental pain models need to be designed with careful consideration of pharmacological mechanisms and pharmacokinetics of analgesics. This knowledge can aid the decisions needed to be taken when designing experimental pain studies for compounds entering phase 1 clinical trials.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Assessing analgesic actions of opioids by experimental pain models in healthy volunteers – an updated review

Staahl

Olesen

Andresen

et al. 2009

Brit J Clinical Pharma

113

131

View full text Add to dashboard Cite

show abstract

“…The dosage of the test drugs in our study was based on the literature [4,8,9,25,30,33,36,44,50]. Our notion was to obtain the greatest analgesic effect with the lowest possible rate of side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Minor complications such as nausea, vomiting, pruritus, and urinary retention did not appear to be related to dose. Arendt-Nielsen et al [4] found that 4 mg epidural morphine at the L2-L3 interspace in healthy volunteers is sufficient to produce hypalgesia from the T6 to S1 dermatomes for more than 7 hours. Banning et al [8] compared oral controlled release morphine and epidural morphine in the management of postoperative pain after knee arthrotomy and reported that 9 of the 10 patients in the epidural morphine group had good relief of pain throughout the study period.…”

Section: Previous Clinical Studies With Epidural Opioidsmentioning

confidence: 98%

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

1996

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The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease. Three treatment groups were constituted: one with 5.0 mg morphine and 2.5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5.0 mg morphine and 0.1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation. In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group. In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.

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Quantitative sensory examination during epidural anaesthesia and analgesia in man: Effects of morphine

Brennum

Arendt-Nielsen

Horn

et al. 1993

Pain

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In a double-blind placebo-controlled cross-over study the effects of epidural morphine (4 mg) on somatosensory functions were investigated in 10 healthy volunteers. Detection, pain detection and pain tolerance thresholds to thermal, mechanical and electrical stimuli as well as magnitude rating of short-lasting stimuli of the same modalities were monitored before and for 10 h after epidural administration of 4 mg of morphine or saline. Epidural morphine induced a naloxone-reversible (0.1 mg/kg, i.v.) increase in pain detection threshold to heat and mechanical stimuli and in pain tolerance threshold to heat, mechanical and electrical stimuli. Morphine induced a more pronounced increase in the pain tolerance than in the pain detection threshold. Magnitude rating of short-lasting radiant heat (argon laser) stimuli were reduced by epidural morphine in comparison to placebo while there was no significant difference between the effects of morphine and placebo on magnitude rating of short-lasting mechanical and electrical stimuli. The warm detection threshold was increased (naloxone reversible) by morphine. Segmental distribution of pruritus was reported by 7 subjects following epidural morphine which was replaced by a short-lasting burning sensation following naloxone administration. Naloxone (0.1 mg/kg) preceeded by placebo did not change somatosensory functions. These results indicate that the somatosensory effect of epidural morphine is dependent on the types of afferent fibres activated as well as on the duration and intensity of the stimulus.

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Hypoalgesia following epidural morphine: a controlled quantitative experimental study

Cited by 17 publications

References 22 publications

Assessing analgesic actions of opioids by experimental pain models in healthy volunteers – an updated review

Assessing analgesic actions of opioids by experimental pain models in healthy volunteers – an updated review

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

Quantitative sensory examination during epidural anaesthesia and analgesia in man: Effects of morphine

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