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64 papers 25 to 100 followers
By Xander Zuidema MD, pharmD, Anesthesiologist, intensivist, pain specialist
Hitoshi Taguchi, Keiko Oishi, Koh Shingu, Hideo Matsumoto, Munehiro Masuzawa
BACKGROUND: A preliminary study has shown effective cancer pain relief by intrathecal betamethasone (ITB). However, further evidence is needed to support this new approach. METHODS: Cancer patients with opioid-resistant pain received lumbar intrathecal administration of betamethasone 2 or 3 mg once a week for 28 days. Immediate and short-term analgesia (using a percentage pain reduction scale and a numerical rating scale, NRS) and long-term analgesia (using NRS) were assessed...
December 7, 2018: Acta Anaesthesiologica Scandinavica
Weston Nadherny, Brooke Anderson, Alaa Abd-Elsayed
INTRODUCTION: There are an ever-increasing number of patients who have implanted devices for targeted delivery of drug therapy to the intrathecal space for the management of spasticity or chronic pain. This leads to a growing number of people with implanted pumps presenting for procedures and surgeries, yet there is a paucity of consolidated information available to describe the appropriate precautions and patient management during this period. METHODS: This was a systematic review to provide a summary of existing literature on intrathecal drug delivery system (IDDS) management in the perioperative and procedural period, and to highlight additional areas that require further research...
October 31, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Shinichi Kokubu, Kelly A Eddinger, Thi M-D Nguyen, Lena Libertad Huerta-Esquivel, Shigeki Yamaguchi, Peter W Schiller, Tony L Yaksh
Background and aims We systematically characterized the potency and side effect profile of a series of small opioid peptides with high affinity for the mu opioid receptor. Methods Male Sprague Dawley rats were prepared with intrathecal (IT) catheters, assessed with hind paw thermal escape and evaluated for side effects including Straub tail, truncal rigidity, and pinnae and corneal reflexes. In these studies, DMT-DALDA (dDAL) (H-Dmt-D-Arg-Phe-Lys-NH2 MW=981), dDALc (H-Dmt-Cit-Phe-Lys-NH2 MW=868), dDALcn (H-Dmt-D-Cit-Phe-Nle-NH2 MW=739), TAPP (H-Tyr-D-Ala-Phe-Phe-NH2 MW=659), dDAL-TICP ([Dmt1]DALDA-(CH2)2-NH-TICP[psi]; MW=1519), and dDAL-TIPP (H-Dmt-D-Arg-Phe-Lys(Nε-TIPP)-NH2 were examined...
October 25, 2018: Scandinavian Journal of Pain
Nai-Jiang Liu, Emiliya M Storman, Alan R Gintzler
We previously showed that spinal mGluR1 signaling suppresses or facilitates (depending on stage of estrous cycle) analgesic responsiveness to intrathecal endomorphin 2 (EM2), a highly mu-opioid receptor (MOR)-selective endogenous opioid. Spinal EM2 antinociception is suppressed during diestrus by mGluR1 when it is activated by membrane estrogen receptor alpha (mERα), and facilitated during proestrus when mGluR1 is activated by glutamate. In the current study, we tested the hypothesis that in female rats subjected to spinal nerve ligation (SNL), inhibition of spinal estrogen synthesis or blockade of spinal mERα/mGluR1 would be anti-allodynic during diestrus, whereas during proestrus mGluR1 blockade would worsen the mechanical allodynia...
October 23, 2018: Journal of Pain: Official Journal of the American Pain Society
Antranig Kalaydjian, Fadi Farah, Yuen Cheng, Martin A Acquadro, Frederic J Gerges
INTRODUCTION: Despite being reported since 1943 as well as being the subject of a large body of literature since that time, no consensus has been reached regarding the etiology of opioid induced hyperalgesia (OIH). It is often described as a paradoxical increased pain response to noxious stimuli due to increased sensitization or an acute tolerance to opioids. CASE: We report the case of a 60 year old patient on chronic Intrathecal combined fentanyl and Bupivacaine who had worsening pain with increasing doses and improved after weaning off intrathecal opioids...
September 29, 2018: Pain Practice: the Official Journal of World Institute of Pain
Felicity Y Han, Andrew Whittaker, Steven M Howdle, Andrew Naylor, Anjumn Shabir-Ahmed, Maree T Smith
Chronic cancer pain remains prevalent and severe for many patients, particularly in those with advanced disease. The effectiveness of analgesic/adjuvant drug treatments in routine practice has changed little in the last 30 years. To address these issues herein, we have developed sustained-release poly(lactic-co-glycolic acid) microparticles of hydromorphone for intrathecal injection aimed at producing prolonged periods of satisfactory analgesia in patients, as a novel strategy for alleviation of intractable cancer-related pain...
September 26, 2018: Journal of Pharmaceutical Sciences
Paolo Maino, Sander M J van Kuijk, Roberto S G M Perez, Eva Koetsier
OBJECTIVES: Structural differences of implantable drug delivery systems (IDDSs) might have an impact on the efficiency of needle access to the reservoir fill port (RFP). The aim of this study was to assess the efficiency of RFP needle access with an ultrasound (US)-guided vs. a blind refill technique in IDDSs with a Recessed RFP (Recessed-RFP-IDDS). MATERIALS AND METHODS: The primary outcome was the number of attempts needed to enter the RFP with a needle comparing the US-guided technique vs...
September 20, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Timothy R Deer, Jason E Pope, Michael C Hanes, Gladstone C McDowell
Objectives: To evaluate the evidence for morphine and ziconotide as firstline intrathecal (IT) analgesia agents for patients with chronic pain. Methods: Medline was searched (through July 2017) for "ziconotide" or "morphine" AND "intrathecal" AND "chronic pain," with results limited to studies in human populations. Results: The literature supports the use of morphine (based primarily on noncontrolled, prospective, and retrospective studies) and ziconotide (based on randomized controlled trials and prospective observational studies) as first-choice IT therapies...
August 22, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Lusine Gomtsian, Kirsty Bannister, Nathan Eyde, Dagoberto Robles, Anthony H Dickenson, Frank Porreca, Edita Navratilova
Modulation of pain may result from engagement of opioid receptors in multiple brain regions. Whether sensory and affective qualities of pain are differentially affected by brain opioid receptor circuits remains unclear. We previously reported that opioid actions within the rostral anterior cingulate cortex (ACC) produce selective modulation of affective qualities of neuropathic pain in rodents, but whether such effects may occur in other areas of the ACC is not known. Here, morphine was microinjected into 3 regions of the ACC or into the rostral ventromedial medulla (RVM), and pain behaviors in naive, sham, or spinal nerve ligated (SNL) rats were evaluated...
August 2, 2018: Pain
Leonardo A Frizon, Navin C Sabharwal, Tanmoy Maiti, Joshua Golubovsky, Francis May, Jianning Shao, Andre G Machado, Sean J Nagel
INTRODUCTION: Implanted intrathecal drug delivery systems (IDDS) are increasingly used in the treatment of spasticity and in patients with refractory pain. Literature discussing complications associated with intrathecal pump placement is widely available. However, reports of complications following the removal of chronically placed catheters are scarce. We reviewed our series of patients who had surgery to remove the intrathecal catheter. METHODS: Retrospective review was performed for all patients who underwent surgery to remove a catheter linked to an IDDS between 2010 and 2016...
October 2018: Neuromodulation: Journal of the International Neuromodulation Society
T Fung, Y I Asiri, K Taheri, R Wall, S K W Schwarz, E Puil, B A MacLeod
BACKGROUND: Neuraxial opioids are widely used for intraoperative and postoperative analgesia. The risk of severe adverse effects including respiratory depression accompanies this analgesia, prompting the need for effective non-opioid alternatives. Systemic 1-amino-1-cyclobutanecarboxylic acid showed promise in preliminary studies to produce antinociception without observable toxicity. However, the effects of 1-amino-1-cyclobutanecarboxylic acid after intrathecal administration are unknown...
August 9, 2018: European Journal of Pain: EJP
Nadir Sharawi, Brendan Carvalho, Ashraf S Habib, Lindsay Blake, Jill M Mhyre, Pervez Sultan
The prevalence of neuraxial opioid-induced clinically significant respiratory depression (CSRD) after cesarean delivery is unknown. We sought to review reported cases of author-reported respiratory depression (ARD) to calculate CSRD prevalence. A 6-database literature search was performed to identify ARD secondary to neuraxial morphine or diamorphine, in parturients undergoing cesarean delivery. "Highest" (definite and probable/possible) and "lowest" (definite) prevalences of CSRD were calculated...
December 2018: Anesthesia and Analgesia
W-Z Zhou, T-Y Zhao, Z-Y Wang, G-Y Lu, S-Z Zhang, C Zhang, N Wu, J Li
BACKGROUND: A combination of analgesic agents with different mechanisms can induce additive or synergistic analgesia. The N-type voltage-dependent calcium channel (N-VDCC) is a novel therapeutic target for pain control. In addition to providing effective pain relief when used alone, N-VDCC blockers produce synergistic analgesia when used in combination with opiates. However, the interaction between N-VDCC blockers and nonsteroidal anti-inflammatory drugs (NSAIDs) remains unclear. METHODS: Using isobolographic analysis and composite additive curve analysis, the antinociceptive interaction between ZC88, a selective N-VDCC blocker and ibuprofen, a classical NSAID, was investigated in two mouse models of visceral and somatic inflammatory pain...
July 5, 2018: European Journal of Pain: EJP
Eric Z Herring, Leonardo A Frizon, Olivia Hogue, Jay U Mejia, Richard Rosenquist, Robert B Bolash, Andre G Machado, Sean J Nagel
Objective: Providing durable long-term pain control for patients with complex regional pain syndrome (CRPS) is challenging. A multidisciplinary approach focused on physical therapy is frequently prescribed, with opioids and invasive procedures reserved for those challenged by functional progression. In this study, we examined the long-term efficacy of intrathecal drug delivery systems (IDDS) in patients with CRPS at our institution. Methods: Patients with CRPS implanted with an IDDS between 2000 and 2013 who had four or more years of continuous follow-up were included in the analysis...
June 7, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
E Bäckryd
Ziconotide is a selective and potent blocker of N-type voltage-gated calcium channels. It was approved by the Food and Drug Administration in 2004 and by the European Medicines Agency in 2005 for the treatment of severe chronic pain in patients needing intrathecal analgesia (ITA). The aim of this paper is to provide a practitioner-oriented, educational, narrative, up-to-date review on the use of ziconotide in clinical pain medicine. Of special concern regarding safety is the partial incongruity between dosing statements in the Summary of Product Characteristics and novel low-dosage, slow uptitration recommendations...
August 2018: European Journal of Pain: EJP
Dawood Sayed, Forrest Monroe, Walter N Orr, Milind Phadnis, Talal W Khan, Edward Braun, Smith Manion, Andrea Nicol
OBJECTIVES: Cancer pain is common and difficult to treat, as conservative medical management fails in approximately 20% of patients for reasons such as intolerable side-effects or failure to control pain. Intrathecal drug delivery systems (IDDS), while underutilized, can be effective tools to treat intractable cancer pain. This study aims to determine the degree of pain relief, efficacy, and safety of patients who underwent IDDS implantation at a multidisciplinary pain clinic. MATERIALS AND METHODS: A retrospective review was conducted of patients with an intrathecal pain pump implanted for malignant pain...
October 2018: Neuromodulation: Journal of the International Neuromodulation Society
Denise M Wilkes, Susan J Orillosa, Erik C Hustak, Courtney G Williams, Gulshan R Doulatram, Daneshvari R Solanki, Eduardo A Garcia, Li-Yen M Huang
Objectives: The goal of this study was to assess the success of the morphine microdose method in a community pain clinic setting by monitoring follow-up frequency, dose escalation, and monotherapy/polytherapy ratio. The morphine microdose method involves a pretrial reduction or elimination of systemic opioids followed by a period of abstinence. Intrathecal (IT) morphine is then started at doses of less than 0.2 mg per day. Systemic opioid abstinence is then continued after pump implant and IT morphine monotherapy...
September 1, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Sean J Nagel, Chandan G Reddy, Leonardo A Frizon, Marshall T Holland, Andre G Machado, George T Gillies, Matthew A Howard
INTRODUCTION: The intrathecal space remains underutilized for diagnostic testing, invasive monitoring or as a pipeline for the delivery of neurological therapeutic agents and devices. The latter including drug infusions, implants for electrical modulation, and a means for maintaining the physiologic pressure column. The reasons for this are many but include unfamiliarity with the central nervous system and the historical risks that continue to overshadow the low complication rates in modern clinical series...
October 2018: Neuromodulation: Journal of the International Neuromodulation Society
(no author information available yet)
No abstract text is available yet for this article.
June 2017: Neuromodulation: Journal of the International Neuromodulation Society
Barbara Kleinmann, Tilman Wolter
OBJECTIVES: Many patients with intrathecal opioid pumps do adhere to the therapy for many years but there is scarce knowledge about the long-term effects of intrathecal opioid therapy (IOT) of more than three years. We sought to assess the long-term efficacy and the presence of typical side-effects and complications of IOT. METHODS: A chart review was conducted on all patients with intrathecal opioid pumps that had been treated at our institution between 1.11.1990 and 31...
October 2017: Neuromodulation: Journal of the International Neuromodulation Society
2017-06-08 21:37:31
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