Stability and Analgesic Efficacy of Di-acetyl Morphine (Diamorphine) Compared with Morphine in Implanted Intrathecal Pumps In Vivo

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

“…[65][66][67][68][70][71][72][73][77][78][79][80][81][82][83][84] This left 10 articles 7,69,74-76,85-89 that met the inclusion criteria for the complications review.…”

Polyanalgesic Consensus Conference 2007: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

“…The panelists addressed a published study by Raphael et al. comparing diamorphine (heroin) and morphine for IT analgesic drug delivery alone or in combination with other agents (172). It had been hypothesized that the greater solubility of diamorphine when compared to morphine would allow for greater concentrations of the agent in the IT drug delivery device.…”

“…All of the panelists endorsed the use of polyanalgesic admixing when monotherapies fail to produce adequate analgesia and all felt that the literature was robust enough to support such a use. The panelists addressed a published study by Raphael et al comparing diamorphine (heroin) and morphine for IT analgesic drug delivery alone or in combination with other agents (172). It had been hypothesized that the greater solubility of diamorphine when compared to morphine would allow for greater concentrations of the agent in the IT drug delivery device.…”

Intrathecal inflammatory masses: is the yearly opioid dose increase an early indicator?

“…Theoretically the greater solubility might have been considered protective for the risk of granuloma; however, we have not found this. The granuloma formation with diamorphine may be a result of diamorphine breaking down into morphine (16).…”