Intraventricular Morphine in Paraneoplastic Painful Syndrome of the Cervicofacial Region: Experience in Thirty-eight Cases

A, Lenzi; Galli, G; Gandolfini, Massimo; Marini, G

doi:10.1227/00006123-198507000-00002

Cited by 36 publications

(5 citation statements)

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“…In humans, intracerebroventricular injection of opioids has been demonstrated in case series to provide powerful analgesia in patients suffering from pain secondary to head and neck cancers. 11,12 Multiple opiate receptor types that produce pain relief independently have been described, indicating the complexity of these pain modulatory systems. Several theories proposed for the mechanism of opiate action include increased descending control, ascending modulation, direct brainstem inhibition, and direct cortical or thalamic inhibition.…”

Section: Communication Between the Spinal Cord And Higher Centersmentioning

confidence: 99%

Neurophysiology of Cancer Pain

Regan

Peng

2000

Cancer Control

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Section: Communication Between the Spinal Cord And Higher Centersmentioning

confidence: 99%

Neurophysiology of Cancer Pain

Regan

Peng

2000

Cancer Control

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“…In humans it is not feasible to routinely assess the site of action within the brain where opiates may act to alter nociceptive transmission. However, intracerebroventricular opioids have been employed in humans for pain relief in cancer patients (124,125,126,127,128). An important characteristic of this action is that the time of onset is relatively rapid for even the water-soluble agent morphine.…”

Section: Supraspinalmentioning

confidence: 99%

Pharmacology and mechanisms of opioid analgesic activity

Yaksh

1997

Acta Anaesthesiol Scand

258

142

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Opiates by an action at specific receptors can induce a highly selective alteration in the response of humans and animals to strong and otherwise aversive chemical, mechanical or thermal stimuli. Specific investigations in a variety of species from rodent to primate using microinjection techniques to examine the pharmacology of local drug action have shown potent antinociceptive actions to be mediated by a receptor specific action at a number of sites within the brain, including the periaqueductal gray (PAG: mu receptor), the rostral ventral medulla (mu/delta receptor) and the substantia nigra (mu receptor) and within the spinal dorsal horn (mu/delta/kappa receptor). Mechanistic studies have shown these actions in the different sites to be mediated by several discrete mechanisms. For example, in the PAG, the local opiate effect is likely mediated by the indirect activation of bulbospinal pathways, rostral projections to forebrain sites and by a local alteration in afferent input into the brainstem core. In the spinal cord, this effect is mediated by an action presynaptic to the primary afferent and by a post-synaptic effect to hyperpolarize projection neurons. In addition, it is now appreciated that mu and kappa receptors in the periphery can modulate the sensitized state of the small afferent terminal innervating inflamed tissue and exert an anti-hyperalgesic action. After systemic delivery of an opiate, it is thus clear that a wide array of central and peripheral systems serve to explain the powerful analgesic effect exerted by this class of agents.

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“…Despite some questioning early on of the rigour of ICV analgesic studies and possible confounding factors [16], subsequent studies seem to support the early promising results. A Cochrane review by Ballantyne and Carwood published in 2005 [17] assessed 13 trials [9, 12, 18–28] of ICV opioids. The majority of the reviewed studies, like the majority subsequently, did not quantify pain relief using a formal measure (e.g.…”

Section: Clinical Resultsmentioning

confidence: 99%

Intracerebroventricular opioids for intractable pain

Raffa

Pergolizzi

2012

Brit J Clinical Pharma

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When pain is refractory to systemic opioid and non-opioid analgesic therapy and palliative chemoradiation or ablative or stimulant neurosurgical procedures are not possible, palliative treatment becomes limited, particularly if the patient wishes to be at home at the end of life. Intracerebroventricular (ICV) infusion of morphine in the home setting might be presented as an option. The present article reviews the basic and clinical evidence of the efficacy and safety of ICV administration of opioids. Information was gathered from various bibliographic sources, including PubMed and others, and summarized and evaluated to assess the efficacy and safety of ICV opioids for pain relief. Results from ICV infusion of morphine into terminally ill patients refractory to other pain treatments have been reported since the early 1980s. Good efficacy has been achieved for the vast majority of patients, without serious development of analgesic tolerance. There have also been a low incidence of adverse effects, such as constipation and respiratory depression, and a significant retention of alertness associated with this route of administration. Intracerebroventricular infusion of opioid analgesics thus appears to be a safe and effective therapy for the palliative treatment of refractory pain.

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Intraventricular Morphine in Paraneoplastic Painful Syndrome of the Cervicofacial Region: Experience in Thirty-eight Cases

Cited by 36 publications

References 0 publications

Neurophysiology of Cancer Pain

Neurophysiology of Cancer Pain

Pharmacology and mechanisms of opioid analgesic activity

Intracerebroventricular opioids for intractable pain

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