Intrathecal clonidine and baclofen enhance the pain-relieving effect of spinal cord stimulation: A comparative placebo-controlled, randomized trial

Neurosurgery

Volumn 67, Issue 1, 2010, Pages 173-181

  Schechtmann, Gastón ^a   Lind, Göran ^a   Winter, Jaleh ^a   Meyerson, Björn A ^a   Linderoth, Bengt ^a  

^a KAROLINSKA UNIVERSITY HOSPITAL   (Sweden)

Author keywords

Baclofen; Clonidine; Neuropathic pain; Spinal analgesia; Spinal cord stimulation

Indexed keywords

BACLOFEN; CLONIDINE; PLACEBO;

ADULT; AGED; ANALGESIA; ARTICLE; CLINICAL ARTICLE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DEEP VEIN THROMBOSIS; DIZZINESS; DOUBLE BLIND PROCEDURE; DRUG DOSE ESCALATION; DRUG EFFECT; DYSPNEA; FEMALE; HUMAN; HYPOTENSION; LEG WEAKNESS; MALE; MUSCLE WEAKNESS; MYOCLONUS; NAUSEA; NEUROPATHIC PAIN; PRIORITY JOURNAL; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL; SEDATION; SIDE EFFECT; SPINAL CORD STIMULATION; XEROSTOMIA;

ADRENERGIC ALPHA-AGONISTS; ADULT; AGED; BACLOFEN; CLONIDINE; DOUBLE-BLIND METHOD; ELECTRIC STIMULATION THERAPY; FEMALE; GABA AGONISTS; HUMANS; INJECTIONS, SPINAL; MALE; MIDDLE AGED; PERIPHERAL NERVOUS SYSTEM DISEASES; PLACEBOS; UP-REGULATION;

EID: 77954110194     PISSN: 0148396X     EISSN: None     Source Type: Journal    
DOI: 10.1227/01.NEU.0000370249.41634.4F     Document Type: Article

References (46)

1. Kemler MA, Barendse GAM, van Kleff M, et al. Spinal cord stimulation in patients with reflex sympathetic dystrophy. N Engl J Med. 2000;343(9):618-624.
2. North RB, Ewend MG, Lawton MT, Kidd DH, Piantadosi S. Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation. Neurosurgery. 1991;28(5):692-699.
3. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef M. Spinal cord stimulation for chronic reflex sympathetic dystrophy-five-year follow-up. N Engl J Med. 2006;354(22):2394-2396.
4. Linderoth B, Simpson BA, Meyerson BA. Spinal cord and brain stimulation. In: McMahon SB, Koltzenburg M, eds. Textbook of Pain. 5th ed. Philadelphia, PA: Elsevier; 2006:563-582.
5. Meyerson BA, Linderoth B. Brain stimulation: intracerebral and motor cortex stimulation. In: Loeser J, ed. Bonica's Management of Pain. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:1877-1889.
6. Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain-some predictors of success. A 15-year experience. Surg Neurol. 1998;50(2):110-120.
7. Stiller CO, Cui JG, O'Connor WT, Brodin E, Meyerson BA, Linderoth B. Release of gamma-aminobutyric acid in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery. 1996;39(2):367-374.
8. Cui JG, Linderoth B, Meyerson BA. Effects of spinal cord stimulation on touch-evoked allodynia involve GABAergic mechanisms. An experimental study in the mononeuropathic rat. Pain. 1996;66(2-3):287-295. (Pubitemid 26283999)
9. Lind G, Meyerson BA, Winter J, Linderoth B. Intrathecal baclofen as adjuvant therapy to enhance the effect of spinal cord stimulation in neuropathic pain: a pilot study. Eur J Pain. 2004;8(4):377-383.
10. Lind G, Schechtmann G, Winter J, Meyerson BA, Linderoth B. Baclofen-enhanced spinal cord stimulation and intrathecal baclofen alone for neuropathic pain: long-term outcome of a pilot study. Eur J Pain. 2008;12(1):132-136.
11. Schechtmann G, Song Z, Ultenius C, Meyerson BA, Linderoth B. Cholinergic mechanisms involved in the pain relieving effect of spinal cord stimulation in a model of neuropathy. Pain. 2008;139(1):136-145.
12. Song Z, Meyerson BA, Linderoth B. Muscarinic receptor activation potentiates the effect of spinal cord stimulation on pain-related behavior in rats with mononeuropathy. Neurosci Lett. 2008;436(1):7-12.
13. Tamsen A, Gordh T. Epidural clonidine produces analgesia. Lancet. 1984;2(8396):231-232.
14. Eisenach JC, DuPen S, Dubois M, Miguel R, Allin D. Epidural Clonidine Study Group: epidural clonidine analgesia for intractable cancer pain. Pain. 1995;61:391-399.
15. Baker A, Klimscha W, Eisenach JC, et al. Intrathecal clonidine for postoperative analgesia in elderly patients: the influence of baricity on hemodynamic and analgesic effects. Anesth Analg. 2004;99(1):128-134.
16. Eisenach JC, Lysak SZ, Viscomi CM. Epidural clonidine analgesia following surgery: phase I. Anesthesiology. 1989;71(5):640-646.
17. Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85(3):655-674.
18. Ackerman LL, Follett KA, Rosenquist RW. Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations. J Pain Symptom Manage. 2003;26(1):668-677.
19. Siddall PJ, Molloy AR, Walker S, Mather LE, Rutkowski SB, Cousins MJ. The efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury. Anesth Analg. 2000;91(6):1493-1498.
20. Mailis-Gagnon A, Furlan AD, Sandoval JA, Taylor R. Spinal cord stimulation for chronic pain. Cochrane Database Syst Rev. 2004;(3):CD003783.
21. Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63(4):762-770.
22. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98-106.
23. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1-2):179-188.
24. Meyerson BA, Linderoth B. Mechanisms of spinal cord stimulation in neuropathic pain. Neurol Res. 2000;22(3):285-292.
25. Martin TJ, Eisenach JC. Pharmacology of opioid and nonopioid analgesics in chronic pain states. J Pharmacol Exp Ther. 2001;299(3):811-817.
26. Schechtmann G, Wallin J, Meyerson BA, Linderoth B. Intrathecal clonidine potentiates suppression of tactile hypersensitivity by spinal cord stimulation in a model of neuropathy. Anesth Analg. 2004;99(1):135-139.
27. Cui JG, Meyerson BA, Sollevi A, Linderoth B. Effect of spinal cord stimulation on tactile hypersensitivity in mononeuropathic rats is potentiated by simultaneous GABA(B) and adenosine receptor activation. Neurosci Lett. 1998;247(2-3):183-186.
28. Cui JG, O'Connor WT, Ungerstedt U, Linderoth B, Meyerson BA. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73(1):87-95.
29. Wallin J, Cui JG, Yakhnitsa V, Schechtmann G, Meyerson BA, Linderoth B. Gabapentin and pregabalin suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy. Eur J Pain. 2002;6(4):261-272.
30. Hood DD, Mallak KA, James RL, Tuttle R, Eisenach JC. Enhancement of analgesia from systemic opioid in humans by spinal cholinesterase inhibition. J Pharmacol Exp Ther. 1997;282(1):86-92.
31. Iwamoto ET, Marion L. Characterization of the antinociception produced by intrathecally administered muscarinic agonists in rats. J Pharmacol Exp Ther. 1993; 266(1):329-338.
32. Kang YJ, Eisenach JC. Intrathecal clonidine reduces hypersensitivity after nerve injury by a mechanism involving spinal m4 muscarinic receptors. Anesth Analg. 2003;96(5):1403-1408.
33. Pan HL, Chen SR, Eisenach JC. Intrathecal clonidine alleviates allodynia in neuropathic rats: interaction with spinal muscarinic and nicotinic receptors. Anesthesiology. 1999;90(2):509-514.
34. Newsome S, Frawley BK, Argoff CE. Intrathecal analgesia for refractory cancer pain. Curr Pain Headache Rep. 2008;12(4):249-256.
35. Schug SA, Saunders D, Kurowski I, Paech MJ. Neuraxial drug administration: a review of treatment options for anaesthesia and analgesia. CNS Drugs. 2006;20(11):917-933.
36. Borg PA, Krijnen HJ. Long-term intrathecal administration of midazolam and clonidine. Clin J Pain. 1996;12(1):63-68.
37. Hassenbusch SJ, Gunes S, Wachsman S, Willis KD. Intrathecal clonidine in the treatment of intractable pain: a phase I/II study. Pain Med. 2002;3(2):85-91.
38. Uhle EI, Becker R, Gatscher S, Bertalanffy H. Continuous intrathecal clonidine administration for the treatment of neuropathic pain. Stereotact Funct Neurosurg. 2000; 75(4):167-175.
39. Bennett G, Serafini M, Burchiel K, et al. Evidence-based review of the literature on intrathecal delivery of pain medication. J Pain Symptom Manage. 2000;20(2):S12-S36.
40. Filos KS, Goudas LC, Patroni O, Polyzou V. Hemodynamic and analgesic profile after intrathecal clonidine in humans. A dose-response study. Anesthesiology. 1994;81(3):591-601.
41. Grace D, Bunting H, Milligan KR, Fee J P. Postoperative analgesia after co-administration of clonidine and morphine by the intrathecal route in patients undergoing hip replacement. Anesth Analg. 1995;80(1):86-91.
42. Lind G, Schechtmann G, Winter J, Linderoth B. Drug-enhance spinal stimulation for pain: a new strategy. In: Sakas DE, Simpson BA, Krames ES, eds. Operative Neuromodulation. Vol 1. New York, NY/Vienna, Austria: Springer; 2007:57-64.
43. McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal baclofen administration. Neurosurgery. 2006;59(3):634-640.
44. Eisenach J, Detweiler D, Hood D. Hemodynamic and analgesic actions of epidu-rally administered clonidine. Anesthesiology. 1993;78(2):277-287.
45. Grabb PA, Guin-Renfroe S, Meythaler JM. Midthoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery. 1999;45(4):833-836.
46. De Kock M, Eisenach J, Tong C, Schmitz AL, Scholtes JL. Analgesic doses of intrathecal but not intravenous clonidine increase acetylcholine in cerebrospinal fluid in humans. Anesth Analg. 1997;84(4):800-803.