Intraventricular morphine for control of pain in terminal cancer patients

Abstract

Satisfactory control of intractable pain has been achieved in 17 terminal cancer patients by injecting small doses of morphine into the lateral cerebral ventricle via an Ommaya reservoir. Pain relief together with a favorable behavioral response was obtained without interference with other sensory modalities, noticeable physical changes, or side effects annoying or severe enough for the patient to discontinue therapy. Eleven patients developed tolerance, but this phenomenon does not require withdrawal of treatment. Chronic intraventricular morphine administration can be safely performed on an outpatient basis, and results in control of midline, bilateral, and diffuse pain associated with orofacial and disseminated cancer. However, this experience is preliminary and further clinical trials are needed to determine the place of this method of therapy in the management of chronic pain.

Withdrawal From Dialysis and Palliative Care for Severely Ill Dialysis Patients in Terms of Patient-Centered Medicine

“…Morphine has been used widely to relieve patients of intractable pain during the terminal phase of cancer [25]. From our experience, we confirm that morphine may also be helpful against respiratory distress following WD.…”

Changes in Hypothalamic Met-Enkephalin Levels of Rats Induced by Painful Stimulation and Morphine Treatment

“…In addition, this type of experimental model is in agreement with the requirement of the Ethical Commission for the Study of Pain in Animals [17,18]. Group 4 rats re ceived morphine chloride (Navarro SA®; 30 pg/kg, the average dose used in humans [19,20] through an ICV cannula), since it has been reported that ICV administration of morphine induces a more intense and longer analgesia than others routes [19,20], Group 5 consisted of rats receiving naloxone (Abello SA®) by intramuscular injection (l ug/kg), the specific dose used in humans [21], Group 6 consisted of rats submitted to a painful stimulus and receiving morphine chloride through an ICV cannula. Group 7 were rats submitted to a painful stimulus and receiving naloxone.…”

Spinal versus Intraventricular Chronic Opiate Administration with Implantable Drug Delivery Devices for Cancer Pain

“…Mi nor and transient side effects, like nausea, vomiting, skin reactions and itching, occurred with the same rate in both [6,8]. Transient urinary re tention is more specific for spinal administration [2,6,10], whereas reversion behavior disorders or dysphoria were significantly reported after intraventricular infusion [7,14].…”

“…Paradoxically, the risks of central respiratory depression are rela tively high after intraventricular administration of low doses of mor phine [6,7,12,14] and can be immediately reversed by naloxone. But all these patients have already received morphine systematically and as a result must have reduced sensitivity of opiate receptors [5,6,12].…”

“…By contrast, development of tolerance is not a serious problem [2,[5][6][7][9][10][11]. So, in practice for cancer pain of the lower part of the body (pelvis and lower limbs), we always start with a percutaneous intrathe cal lumbar trial.…”