Patient selection and trialing techniques utilizing low-dose intrathecal morphine for chronic nonmalignant pain: A report of two cases

Journal of Opioid Management

Volumn 6, Issue 5, 2010, Pages 371-376

  Grider, Jay S ^a   Harned, Michael E ^a   Sloan, Paul A ^a  

^a UNIVERSITY OF KENTUCKY   (United States)

Author keywords

Chronic nonmalignant pain; Intrathecal analgesics; Intrathecal drug delivery; Intrathecal morphine; Low dose opioid

Indexed keywords

AMITRIPTYLINE; GABAPENTIN; HYDROCODONE; METHADONE; MORPHINE; OPIATE; OXYCODONE; PARACETAMOL; TIAGABINE; TOPIRAMATE;

ADULT; ANALGESIA; ARTICLE; BEDTIME DOSAGE; CASE REPORT; CHRONIC PAIN; CLINICAL PRACTICE; CLINICAL PROTOCOL; CONTINUOUS INFUSION; DRUG DELIVERY SYSTEM; DRUG DOSE ESCALATION; DRUG DOSE INCREASE; DRUG DOSE TITRATION; DRUG EFFICACY; DRUG WITHDRAWAL; FEMALE; HUMAN; IMPLANTATION; INFUSION SYSTEM; LOW BACK PAIN; LOW DRUG DOSE; MORNING DOSAGE; NUMERIC PAIN RATING SCALE; PAIN ASSESSMENT; PATIENT SELECTION; PRACTICE GUIDELINE; RATING SCALE; TREATMENT OUTCOME; UNSPECIFIED SIDE EFFECT; CHRONIC DISEASE; DOSE RESPONSE; INTRASPINAL DRUG ADMINISTRATION; MIDDLE AGED; PAIN;

CHRONIC DISEASE; DOSE-RESPONSE RELATIONSHIP, DRUG; FEMALE; HUMANS; INJECTIONS, SPINAL; MIDDLE AGED; MORPHINE; PAIN; PATIENT SELECTION;

EID: 78349245887     PISSN: 15517489     EISSN: None     Source Type: Journal    
DOI: 10.5055/jom.2010.0035     Document Type: Article

References (23)

1. Wallace M, Yaksh TL: Long-term spinal analgesic delivery: A review of the preclinical and clinical literature. Reg Anesth Pain Med. 2002; 25(2): 117-157.
2. Deer TR, Kim C, Bowman R, et al.: Intrathecal ziconotide and opioid combination therapy for noncancer pain: An observational study. Pain Physician. 2009; 12: E291-E296.
3. Sloan PA, Babul N: Extended-release opioids for the management of chronic nonmalignant pain. Expert Opin Drug Deliv. 2006; 3: 489-497.
4. Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10: 113-130.
5. American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine: Practice guidelines for chronic pain management. Anesthesiology. 2010; 112: 810-833.
6. Turner MS: Intrathecal drug delivery. Acta Neurochir. 2003; 87: 29-35.
7. Coffey RJ, Owens ML, Broste SK, et al.: Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain. Anesthesiology. 2009; 111: 881-891.
8. Flood P: Death after initiation of intrathecal drug therapy for chronic pain: Assessing risk and designing prevention. Anesthesiology. 2009; 111: 706-708.
9. Witt WO, Richardson WB: Intrathecal low dose morphine; case study 3 and 4. SynchroMed 2 programmable infusion system. Product Bulletin. Minneapolis, MN: Medtronic Neuromodulation, 2010.
10. Waldman SD, Feldstein GS, Allen ML, et al.: Selection of patients for implantable intraspinal narcotic delivery systems. Anesth Analg. 1986; 65: 883-885.
11. Krames ES: Intrathecal infusion therapies for intractable pain: Patient guidelines. J Pain Symptom Manage. 1993; 8: 36-46.
12. Krames ES: Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines. J Pain Symptom Manage. 1996; 11: 335-352.
13. Krames ES: Implantable devices for pain control: Spinal cord stimulation and intrathecal therapies. Best Pract Res Clin Anaesthesiol. 2002; 16: 619-649.
14. Auld AW, Maki-Jokela A, Murdoch DM: Intraspinal narcotic analgesia in the treatment of chronic pain. Spine. 1985; 10: 777-781.
15. Coombs DW, Saunders RL, Gaylor MS, et al.: Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir. JAMA. 1983; 250(17): 233-239.
16. Crawford ME, Anderson HB, Augustenborg G, et al.: Pain treatment on outpatient basis utilizing extradural opiates. A Danish multicenter study comprising 105 patients. Pain. 1983; 16: 484-491.
17. Kayser V, Besson JM, Guilbaud G: Paradoxical hyperalgesic effect of exceedingly low doses of systemic morphine in an animal model of persistent pain (Freund's adjuvant-induced arthritic rats). Brain Res. 1987; 414(1): 155-157.
18. Crain SM, Shen KF: Acute thermal hyperalgesia elicited by low-dose morphine in normal mice is blocked by ultra-low-dose naltrexone, unmasking potent opioid analgesia. Brain Res. 2001; 888(1): 75-82.
19. van der Kooy D, Nagy JI: Hyperalgesia mediated by peripheral opiate receptors in the rat. Behav Brain Res. 1985; 17(3): 203-211.
20. Grider JS, Ackerman WE: Opioid-induced hyperalgesia and tolerance: Understanding opioid side effects. Expert Rev Clin Pharmacol. 2008; 1: 291-297.
21. Andrews HL: The effect of opiates on the pain threshold in post-addicts. J Clin Invest. 1943; 22: 511-516.
22. Blay M, Orban JC, Rami L, et al.: Efficacy of low-dose intrathecal morphine for postoperative analgesia after abdominal surgery; a double-blinded randomized study. Reg Anesth Pain Med. 2006; 131(2): 127-133.
23. Rathmell JP, Miller MJ: Death after initiation of intrathecal drug therapy for chronic pain. Anesthesiology. 2009; 111: 706-708.