Neuromodulation of pain: A consensus statement prepared in Brussels 16–18 January 1998 by the following task force of the European Federation of IASP Chapters (EFIC)

Gybels, Jan; Erdine, Serdar; Maeyaert, Jan; Meyerson, Björn A.; Winkelmüller, Wolfrat; Augustinsson, Lars-Erik; Bonezzi, C.; Brasseur, L.; DeJongste, Mike J. L.; Kupers, Ron; Marchettini, Paolo; Müller-Schwefe, Gerhard; Nitescu, Petre; Plaghki, Léon; Reig, Enrique; Spincemaille, G.H.; Thomson, StClair; Tronnier, V.; Buyten, Jean Pierre Van

doi:10.1016/s1090-3801(98)90016-7

Cited by 102 publications

(31 citation statements)

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“…In a first review regarding adverse events with the use of intrathecal opioids, endocrine side-effects, such a loss of libido, were virtually absent (23). Later reports mentioned disturbance of libido in 4.9% (24), amenorrhea in 2.4%, and loss of potency in 26.8% of patients (8). Although sexual dysfunction as an adverse event of intrathecal opioids was gradually recognized in the literature, the reported figures were considered an underestimation.…”

Section: Discussionmentioning

confidence: 99%

“…Other medications, such as clonidine, nonsteroidal antiinflammatory drugs, neostigmine, ketamine, octreotide, and aspirin, can be added intrathecally to enhance the analgesic effects of morphine (7). By contrast, the hope that the intrathecal administration of opioids would substantially reduce the number of side-effects associated with oral morphine has not been fulfilled (8). Sedation is less pronounced, but pruritus and urinary retention are more frequently seen.…”

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confidence: 99%

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Endocrine Consequences of Long-Term Intrathecal Administration of Opioids

Abs

Verhelst

Maeyaert³

et al. 2000

The Journal of Clinical Endocrinology &Amp; Metabolism

362

146

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Intrathecal administration of opioids is a very efficient tool in the long-term control of intractable nonmalignant pain. However, despite the well known role of opioids in endocrine regulation, few data are available about possible effects on hypothalamic-pituitary function during this treatment.Seventy-three patients (29 men and 44 women; mean age, 49.2 Ϯ 11.7 yr) receiving opioids intrathecally for nonmalignant pain were enrolled for extensive endocrine investigation. At the time of hormonal determination, the mean duration of opioid treatment was 26.6 Ϯ 16.3 months; the mean daily dose of morphine was 4.8 Ϯ 3.2 mg. The control group consisted of 20 patients (11 men and 9 women; mean age, 54.2 Ϯ 14.0 yr) with a comparable pain syndrome but not treated with opioids.Decreased libido or impotency was present in 23 of 24 men receiving opioids. The serum testosterone level was below 9 nmol/L in 25 of 29 men and was significantly lower than that in the control group (P Ͻ 0.001). The free androgen index was below normal in 18 of 29 men and was significantly lower than that in the control group (P Ͻ 0.001). The serum LH level was less than 2 U/L in 20 of 29 men and was significantly lower than that in the control group (P Ͻ 0.001). Serum FSH was comparable in both groups. Decreased libido was present in 22 of 32 women receiving opioids. All 21 premenopausal females developed either amenorrhea or an irregular menstrual cycle, with ovulation in only 1. Serum LH, estradiol, and progesterone levels were lower in the opioid group. In all 18 postmenopausal females significantly decreased serum LH (P Ͻ 0.001) and FSH (P ϭ 0.012) levels were found. The 24-h urinary free cortisol excretion was below 20 g/day in 14 of 71 opioid patients and was significantly lower than that in the control group (P ϭ 0.003). The peak cortisol response to insulin-induced hypoglycemia was below 180 g/L in 9 of 61 opioid patients and was significantly lower than that in the nonopioid group (P ϭ 0.002). The insulin-like growth factor I SD score was below Ϫ2 SD in 12 of 73 opioid patients and was significantly lower than that in the control group (P ϭ 0.002). The peak GH response to hypoglycemia was below 3 g/L in 9 of 62 subjects and was significantly lower than that in the control group (P ϭ 0.010). Thyroid function tests and PRL levels were considered normal. No metabolic disturbances were recorded, apart from significantly decreased high density lipoprotein cholesterol levels (P ϭ 0.041) and elevated total/high density lipoprotein cholesterol ratio (P ϭ 0.008) in the opioid group compared to the control group. Supplementation with gonadal steroids improved sexual function in most patients.In conclusion, of all patients receiving intrathecal opioids, the large majority of men and all women developed hypogonadotropic hypogonadism, about 15% developed central hypocorticism, and about 15% developed GH deficiency. These findings suggest that further investigations are required to determine the need for systematic endocrine work-up in these pa...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endocrine Consequences of Long-Term Intrathecal Administration of Opioids

Abs

Verhelst

Maeyaert³

et al. 2000

The Journal of Clinical Endocrinology &Amp; Metabolism

362

146

View full text Add to dashboard Cite

show abstract

“…Consideration of highly invasive procedures such as insertion of intrathecal infusion pumps or spinal cord stimulators is generally reserved for patients with no surgically treatable pathology who have failed more conservative treatments and undergone psychological evaluation. 123 Although this level of caution may also be applied to nerve block procedures, some conditions could warrant nerve blocks earlier in the clinical course. For example, sympathetic nerve blocks in early complex regional pain syndrome may be a crucial adjunct for the facilitation of physiotherapy and rehabilitation.…”

Section: Interventional Pain Managementmentioning

confidence: 99%

Neuropathic pain: a practical guide for the clinician

Gilron

Watson²,

Cahill³

et al. 2006

Canadian Medical Association Journal

379

275

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“…Every year, approximately 15,000 patients worldwide are treated with this method because of neuropathic and ischemic pain (Cameron, 2004). In Europe, approximately 5000 stimulators are implanted because of pain of various origins (Gybels et al, 1998).…”

Section: Discussionmentioning

confidence: 99%