scholarly journals Two Cases of Intractable Cancer Pain Patients Who Received High Dose Intrathecal or Epidural Morphine

2021 ◽  
Vol 41 (5) ◽  
pp. 447-450
Author(s):  
Keiko IWASAKI ◽  
Yumi MITO ◽  
Miwako KATAGIRI ◽  
Saeko MIYAZAKI
Keyword(s):  
Cancer Pain ◽  
Epidural Morphine ◽  
High Dose ◽  
Intractable Cancer Pain ◽  
Pain Patients

scholarly journals Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E905-E915
Author(s):  
Hélène Staquet
Keyword(s):  
Neuropathic Pain ◽  
Side Effects ◽  
Cancer Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Third Ventricle ◽  
High Dose ◽  
Intractable Pain ◽  
Intracerebroventricular Infusion ◽  
Intractable Cancer Pain

Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/ or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications. Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/dy and up to a median of 1.2 µg/dy [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/dy [0.24; 0.66] up to 0.6 mg/dy [0.45; 4.63] and 1.2 mg/dy [0; 2.4] up to 2.23 mg/dy [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. Key words: Intracerebroventricular infusion, ziconotide, intractable pain, nociceptive and neuropathic pain

Opioid tapering following the transfer of care of outpatient chronic non-cancer pain patients on high-dose opioid therapy

2020 ◽  
pp. rapm-2020-102191
Author(s):  
Kenneth B Chapman ◽  
Martijn M Pas ◽  
Latrice Akuamoah ◽  
Timothy R Deer ◽  
Noud van Helmond
Keyword(s):  
Cancer Pain ◽  
Opioid Therapy ◽  
High Dose ◽  
Transfer Of Care ◽  
Opioid Tapering ◽  
Pain Patients

scholarly journals Ziconotide Adverse Events in Patients with Cancer Pain: A Multicenter Observational Study of a Slow Titration, Multidrug Protocol

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. 395-403
Author(s):  
Denis Dupoiron
Keyword(s):  
Adverse Events ◽  
Cancer Pain ◽  
Initial Dosage ◽  
Oral Morphine ◽  
Intrathecal Therapy ◽  
High Dose ◽  
Serious Adverse Events ◽  
Patients With Cancer ◽  
Intractable Cancer Pain ◽  
Intrathecal Analgesia

Background: Ziconotide is a new analgesic agent administered intrathecally. It is challenging to use and can induce several and sometimes serious adverse events. A low initial dosage followed by slow titration may reduce serious adverse events. Objective: To determine whether a low starting dosage of ziconotide, followed by slow titration, decreases the incidence of major adverse events associated with ziconotide when used for intractable cancer pain. Study Design: Observational cohort study. Setting: Three French cancer centers. Methods: Patients with incurable cancer causing chronic pain rated above 6/10 on a numerical scale while receiving high-dose opioid therapy (more than 200 mg/d of oral morphine equivalent) and/or exhibiting severe opioid-related adverse events received intrathecal infusions of ziconotide combined with morphine, ropivacaine, and clonidine. Results: Seventy-seven patients were included. Adverse events were recorded in 57% of them; moderate adverse events occurred in 51%. Adverse events required treatment discontinuation in 7 (9%) including 5 (6%) for whom a causal role for ziconotide was highly likely; among them 4 (5%) were serious. All patients experienced a significant and lasting decrease in pain intensity (by 48%) in response to intrathecal analgesic therapy that included ziconotide. Limitations: Limitations include the nonrandomized, observational nature of the study. Determining the relative contributions of each drug to adverse events was difficult, and some of the adverse events manifested as clinical symptoms of a subjective nature. Conclusions: The rates of minor and moderate adverse events were consistent with previous reports. However, the rate of serious adverse events was substantially lower. Our study confirms the efficacy of intrathecal analgesia with ziconotide for relieving refractory cancer pain. These results indicate that multimodal intrathecal analgesia in patients with cancer pain should include ziconotide from the outset in order to provide time for subsequent slow titration. Key words: Ziconotide, adverse events, intrathecal therapy, cancer pain, morphine, ropivacaine, clonidine.

Constant infusion of morphine for intractable cancer pain using an implanted pump

1990 ◽  
Vol 73 (3) ◽  
pp. 405-409 ◽  
Author(s):  
Samuel J. Hassenbusch ◽  
Prem K. Pillay ◽  
Michelle Magdinec ◽  
Kathleen Currie ◽  
Janet W. Bay ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Control ◽  
Epidural Morphine ◽  
High Rate ◽  
Constant Infusion ◽  
Intractable Pain ◽  
Content Type ◽  
Terminally Ill Cancer Patients ◽  
Epidural Catheters ◽  
Intractable Cancer Pain

✓ In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients evaluated for eligibility experienced good pain control during trial assessment and were subsequently implanted with Infusaid infusion pumps. Preinfusion pain analog values were 8.6 ± 0.3 and postimplantation values at 1 month were 3.8 ± 0.4 (p < 0.001). Over this same 1-month period, requirements of systemic morphine equivalents decreased by 79.3% with epidural infusions as compared to preinfusion requirements (p < 0.001 ). There were no instances of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockage. One patient developed apparent drug tolerance and three patients required further catheter manipulations. This series strongly suggests that significant reductions in cancer pain can be obtained with few complications and a low morphine tolerance rate using chronic epidural morphine infusion. Anesthesiology and psychiatry input, along with temporary catheter infusion screening and quantitative pain evaluations using analog scales, are essential.

679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A265-A266
Author(s):  
Yishi Sun ◽  
Isabelle Laksono ◽  
Janannii Selvanathan ◽  
Aparna Saripella ◽  
Mahesh Nagappa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Cancer Pain ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Pain Group ◽  
Pooled Prevalence ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Introduction In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Methods Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain &gt;3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of &gt; 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. Results The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p &lt; 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p &lt; 0.05). Conclusion In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain. Support (if any):

Gabapentin enhances the antinociceptive effect of intrathecal morphine in refractory cancer pain patients

2021 ◽  
Author(s):  
Lei Teng ◽  
Junzhu Dai ◽  
Hongxue Shao ◽  
Liuyuan Zhao ◽  
Shiyan Lin ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Intrathecal Morphine ◽  
Antinociceptive Effect ◽  
Pain Patients
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