Intrathecal analgesia for refractory cancer pain

Newsome, Scott D.; Frawley, Bridget K.; Argoff, Charles E.

doi:10.1007/s11916-008-0043-0

Cited by 34 publications

(24 citation statements)

References 49 publications

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“…SST has been proved to modulate the activity of sensory neurons (Malcangio, 2003) and its synthetic analogue OCT has recently gained increasing attention in the clinical treatment of chronic and cancer pain (Schwetz et al, 2004; Newsome et al, 2008; Gachago and Draganov, 2008), but the mechanisms underlying its effects are still largely obscure. In animal models, OCT anti‐hyperalgesic effects were mainly observed following intrathecal administration (Su et al, 2001), suggesting the involvement of spinal rather than peripheral mechanisms.…”

Section: Discussionmentioning

confidence: 99%

The somatostatin analogue octreotide inhibits capsaicin‐mediated activation of nociceptive primary afferent fibres in spinal cord lamina II (substantia gelatinosa)

Bencivinni

Ferrini

Salio

et al. 2011

European Journal of Pain

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Somatostatin (SST) in spinal cord has been linked with the inhibition of nociceptive neurotransmission in several experimental paradigms. The SST2 receptor (SSTR2) is the main SST receptor subtype in the superficial dorsal horn (DH) and is activated, besides to the naïve peptide, by the SST synthetic analogue octreotide (OCT). In the present work, we have studied the central effects of SSTR2 activation on capsaicin (CAP)-induced glutamate release in mouse DH. In neurons of the lamina II of DH, CAP (2 μM) induced a strong increase of mEPSC frequency that was significantly reduced (70%) by OCT. SSTR2 involvement was assessed by using the specific antagonist CYN 154806. No differences were observed between frequency increase in CAP alone vs. CAP in the presence of CYN 154806+OCT. The effect of OCT was further investigated by studying c-fos expression in spinal cord slices. The CAP-induced increase in density of Fos immunoreactive nuclei in the superficial DH was strongly prevented by OCT. SSTR2a (a splicing variant of SSTR2) immunoreactivity was found in both pre- and post-synaptic compartments of laminae I-II synapses. By light and electron microscopy, SSTR2a was mainly localized onto non-peptidergic isolectin B4 (IB4)-positive primary afferent fibres (PAFs). A subset of them was also found to express the CAP receptor TRPV1. These data show that the SST analogue OCT inhibits CAP-mediated activation of non-peptidergic nociceptive PAFs in lamina II. Our data indicate that SSTR2a plays an important role in the pre-synaptic modulation of central excitatory nociceptive transmission in mouse.

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Section: Discussionmentioning

confidence: 99%

The somatostatin analogue octreotide inhibits capsaicin‐mediated activation of nociceptive primary afferent fibres in spinal cord lamina II (substantia gelatinosa)

Bencivinni

Ferrini

Salio

et al. 2011

European Journal of Pain

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“…[7] For patients who failed to respond to conservative medications, there was increasing evidence that the intrathecal (IT) route provided more effective analgesia, especially when efficacy was limited by dose-dependent toxicity. [8,9] The aim of our study was to observe the clinical response of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients who required a more effective management than conservative administration to control pain.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies

Zheng

Yang

et al. 2017

Medicine

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Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients.A prospective cohort study was performed between July 2015 and October 2016. Fifty-three patients undergoing intractable cancer-related pain or intolerable drug-related adverse effects were recruited and received IDDS therapy with a patient-controlled intrathecal analgesia pump. The assessment was conducted during admission, in titration period, and followed up monthly to death by scheduled refill visits. Pain numeric rating scale scores, comprehensive toxicity scores, quality of life scores, systemic opioid use (basal and breakthrough dose), intrathecal morphine use (basal and patient-controlled intrathecal analgesia dose), and complications were recorded to evaluate the curative effect and safety.Between baseline and all subsequent follow-ups, statistically significant decreases in pain numeric rating scale scores and comprehensive toxicity scores were verified. A statistical improvement in quality of life scores was found after starting IDDS therapy. Both basal and breakthrough doses of systemic opioid showed a significant decrease during the follow-up period. And there was a modest escalation in the intrathecal morphine dose throughout the duration of study. No infective, device-related, and catheter-related complications were observed.The findings showed that IDDS therapy allowed for rapid and highly effective pain relief with less toxicity in comparison to conservative medications. Patients with advanced malignancies would also benefit from an improvement in the life quality after the procedure. IDDS therapy represented a valuable option for intractable cancer-related pain management.

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“…Experience in this field, however, has been limited to case reports [10][11][12] . Among these, the intrathecal narcotic pump infusion (ITNP) is the most studied modality for control of intractable pain in cancer as well as non-cancer patients but with variable level of success [13][14][15][16] . The ITNP consists of a channeled catheter intrathecally (into the subarachnoidal space) that is connected to a small battery-powered programmable pump which is placed in the subcutaneous tissue of the abdominal wall.…”

Section: Introductionmentioning

confidence: 99%

Total pancreatectomy with islet cell transplantationvsintrathecal narcotic pump infusion for pain control in chronic pancreatitis

Mokadem

Noureddine

Howard

et al. 2016

WJG

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Intrathecal analgesia for refractory cancer pain

Cited by 34 publications

References 49 publications

The somatostatin analogue octreotide inhibits capsaicin‐mediated activation of nociceptive primary afferent fibres in spinal cord lamina II (substantia gelatinosa)

The somatostatin analogue octreotide inhibits capsaicin‐mediated activation of nociceptive primary afferent fibres in spinal cord lamina II (substantia gelatinosa)

Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies

Total pancreatectomy with islet cell transplantationvsintrathecal narcotic pump infusion for pain control in chronic pancreatitis

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