Pain Of Malignant Origin Research Articles

Neurolytic blocks revisited

The use of neurolytic blockade is a staple in the management of cancer pain. However, the data on neurolysis for chronic pain are plagued by inconsistencies in patient selection, diagnostic criteria, technical standards, and outcome measures. No one neurolytic agent or technique has been proven superior to another. Current evidence suggests that patients with pain of malignant origin may benefit from a variety of neurolytic techniques, as the benefit of documented short-term pain relief may outweigh risk at the end of life. In the absence of compelling data suggesting low-risk long-term efficacy, neurolysis for chronic benign pain should be cautiously considered, in most cases, only after failure of aggressive multidisciplinary management.

Analgesic responses to intrathecal morphine in relation to CSF concentrations of morphine-3,β-glucuronide and morphine-6,β-glucuronide

This study was performed to determine whether variations in analgesic responses to intrathecal morphine could be explained by cerebrospinal fluid (CSF) concentrations of morphine metabolites. Twenty-four CSF samples were collected at the beginning, middle and end of treatment periods in seven cancer patients with pain of malignant origin. CSF concentrations of morphine-3,β-glucuronide (M3G) and morphine-6,β-glucuronide (M6G) metabolites were measured by gas chromatography/mass spectrometry. Analgesic responses to morphine were estimated concurrent with CSF collection using a visual analog scale representing percentages of pain relief. Effective analgesia was defined as ≥ 75% pain relief. CSF concentration of M3G and M6G in the 24 samples were 722 ± 116 ng/ml and 699 ± 158 ng/ml, respectively. CSF samples were categorized into two groups: (1) those collected during effective analgesia (N = 14), and (2) those collected during ineffective analgesia (N = 10). M6G levels detected in group 1 samples (effective analgesia) were significantly greater than those found in group 2 samples (ineffective analgesia) (978 ± 243 ng/ml vs 309 ± 68 ng/ml, P < 0.05). Intergroup differences in CSF M3G concentrations and M3G M6G ratios were not significant. It is concluded that CSF M6G may be indicative of effectiveness of analgesia in cancer patients subjected to intrathecal morphine.

Advances in cancer pain.

Advances in cancer pain research and management are an example of the advances that have occurred within the field of neuro-oncology, the medical discipline that includes the diagnosis and treatment of primary central nervous system neoplasms, metastatic and nonmetastatic neurological complications of cancer originating outside the nervous system, and pain associated with cancer. Progress in the diagnosis and treatment of cancer, coupled with advances in our understanding of the anatomy, physiology, pharmacology, and psychology of pain perception, has led to improved care of the patient with pain of malignant origin. Currently, specialized methods of cancer diagnosis and treatment provide the most direct approach to treating cancer pain by treating the cause of the pain. Yet, before the introduction of successful antitumor therapy, when treatment of the cause of the pain has failed or when injury to bone, soft tissue, or nerve has occurred as a result of therapy, appropriate pain management is essential.

Intrathecal morphine in the treatment of chronic intractable pain.

Fifteen patients with intractable pain received intrathecal morphine delivered via a programmable (Medtronic) device. In twelve patients the pain was due to cancer and three patients had pain of non malignant origin. All of the patients reported excellent or good relief. A total of 14 complications were reported in 7 patients. Most of these were minor and related to surgical or mechanical problems. One patient with pain of non malignant origin developed serious complications which required the removal of the infusion device. The results of this study show that chronic intrathecal infusion of morphine is superior to conventional forms of analgesia in patients with intractable pain of malignant origin. We would advise that it should remain a therapy of last resort in patients with intractable non malignant pain as the long term side effects are still unknown and the potential for serious side effects still exists.

Bioavailability and analgesic effect of sustained release cetobemidone capsules in cancer patients with chronic pain of malignant origin.

Ever since its introduction in 1952, Ketogan has consisted of a combination of the opioid cetobemidone and a spasmolytic drug, A29, in the ratio of 1:5. Its main limitations are the relatively short duration of action and an apparent ceiling effect due to A29. We therefore developed a cetobemidone formulation with sustained release properties (cetobem. s.r.). Forty-seven patients with advanced cancer with moderate/severe pain, treated with regular doses of Ketogan tablets took part in an open phase 1 type pharmacologic/toxicologic study comparing Ketogan tablets and cetobem. s.r. The patients spent at least 4 days in the department. After evaluation during 12 h with Ketogan tablets (3-4 dosing intervals), a loading phase lasting for 36 h with cetobem. s.r. given twice/24 h (total dose of Ketogan tablets per 24 h divided by 2), and synchronous reduction of the dose of Ketogan tablets, a similar evaluation period of 12 h was performed when on treatment with cetobem. s.r. alone. Comparison of data from the two observation periods showed the following: Average relative bioavailability 0.77 SD 0.28. Only 2 patients were remedicated before 12 h when on cetobem. s.r. Duration of action mean 11.9 h, SD 0.3 h. There was no significant difference between Ketogan tablets and cetobem. s.r. periods concerning 'time with no pain'. Side-effects were few. The only significant difference was dry mouth being more severe during the tablet period. Vital signs were unaffected by treatment. It is concluded that cetobem. s.r. can be given every 12 h to cancer patients with chronic pain with satisfactory analgesic effect, a very modest change in side-effect profile and no significant effects on vital signs when substituting cetobem. s.r. for Ketogan tablets in equal daily doses.

Implantable drug delivery systems: Practical considerations

Spinal opioids have dramatically changed the way acute, obstetrical and pain of malignant origin is managed. The development of various implantable narcotic delivery systems has complemented and facilitated the growth of this treatment modality. By interfacing appropriate patient selection with the unique advantages and disadvantages of each of the six types of implantable narcotic delivery systems, improved results both in terms of pain relief and patient satisfaction can be achieved.

Selection of Implantable Narcotic Delivery Systems

Intraspinal narcotics have dramatically influenced the way pain of malignant origin is managed. There has been a rapid acceptance of this modality within the anesthesia community to treat a wide variety of cancer pain problems. In tandem the development of various implantable narcotic delivery systems has complemented and facilitated the expanded role of intraspinal narcotics in the treatment of cancer pain. Appropriate patient selection is crucial if optimal results are to be achieved. Factors to be considered in patient selection should include the results of the preimplantation spinal narcotic trial, infection trial, infection and local conditions, hematologic status, physiologic and behavioral abnormalities, cost, patient support systems and life expectancy. By interfacing these factors with the unique profiles that each of the five types of implantable narcotic delivery systems offer, improved results both in terms of pain relief and patient satisfaction can be expected.

Analgesic Effect of Alprazolam in Patients with Chronic, Organic Pain of Malignant Origin

Effective analgesia is a crucial factor in promoting quality of life for cancer patients. While undergoing treatment with the minor tranquilizer alprazolam for a coincidental psychiatric disturbance, 39 patients with malignancies and an associated causalgic pain syndrome had a marked analgesic response. Diagnostic and treatment guidelines for organic pain syndromes are reviewed, as are indications for the use of anticonvulsants and benzodiazepines as analgesic adjuvants. The results of this study suggest that the use of benzodiazepines for patients with this refractory pain syndrome should be evaluated further.

Neuroadenolysis of the pituitary:Description of a modified technique

Abstract Neuroadenoylysis of the pituitary (NALP) has been found to be an effective technique in relieving pain of malignant origin. This paper describes a modified technique using a single small needle through a needle. This modified technique was used on 15 consecutive patients with intractable diffuse painof malignant origin whose pain was not controlled by conventional treatment modalities. Nine of 15 patients (60%) experienced excellent pain relief, defined as the need for no narcotic analgesics to control their pain. Five of 15 patients (33%) reported good pain relief, defined as complete pain control with adjunctive oral narcotic analgesics given on an around-the-clock basis. One patient (7%) had poor relief of pain, defined as incomplete pain control despite use of narcotic analgesics. No permanent complications were observed. It appears that this modified approach to NALP provides a safe effective means of relievingpain of malignant origin with a decreased incidence of side effects.

A troubleshooting guide to the subcutaneous epidural implantable reservoir.

Abstract The use of intraspinal narcotics to relieve pain of malignant origin represents a great advance in cancer pain management. Implantation of subcutaneous intraspinal narcotic delivery systems for pain relief has been used with minimal complications. Occasionally problems arise. The purpose of this article is to review the various causes of reservior failure, their diagnosis, and the methods to correct them.

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders.

The INFUSAID model #400 totally implantable drug delivery system was implanted in 17 patients for the continuous infusion of spinally administered preservative-free morphine sulfate. Sixteen patients had pain of malignant origin, and one patient had pain secondary to meningomyelocele. Over time, there was a consistent mean improvement in analgesia scores ranging from 50% to 70% of the control levels for 16 of the patients with cancer-related pain. This form of pain therapy was not successful in treating the benign pain of the patient with meningomyelocele. Overall, the patients with cancer were pleased with their pain therapy, experienced few complications, and reported improved quality of life. Continuous infusion of spinally administered narcotics using a totally implantable drug delivery system such as the INFUSAID model #400 is a safe, complication-free procedure for the control of cancer-related pain.

Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin

Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin

Continuous Low-dose Intrathecal Morphine Administration in the Treatment of Chronic Pain of Malignant Origin

Continuous Low-dose Intrathecal Morphine Administration in the Treatment of Chronic Pain of Malignant Origin

Arterial infusion of nitrogen mustard in the treatment of intractable pelvic pain of malignant origin.

Sixty-two patients with intractable pelvic pain secondary to malignancy arising in the pelvis received a total of 72 percutaneous retrograde arterial infusions with nitrogen mustard. Fifty-three (74%) injections resulted in marked relief of pain for an average period of six to eight weeks. Five (7%) produced no pain relief. Toxicity was mild. There were two severe complications and no deaths related to the procedure or the drug in this study. Percutaneous retrograde arterial infusion with nitrogen mustard is suggested as the preferred procedure in the attempt to control pelvic pain caused by malignancy, before resorting to spinal cordotomy or intrathecal alcohol injection.