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15 - Neuraxial analgesia

from SECTION IV - PHARMACOLOGICAL TREATMENT

Published online by Cambridge University Press:  06 July 2010

By
LEWIS C. HOLFORD  and
MICHAEL COUSINS
Edited by
Eduardo D. Bruera  and
Russell K. Portenoy
LEWIS C. HOLFORD
Affiliation:
University of Sydney at Royal North Shore Hospital
MICHAEL COUSINS
Affiliation:
University of Sydney at Royal North Shore Hospital
Eduardo D. Bruera
Affiliation:
University of Texas, Houston
Russell K. Portenoy
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

Introduction

Improvements in the understanding of the pathophysiology of pain, increased availability of pharmacological agents, adoption of different modes of drug administration, and development of comprehensive multidisciplinary care all have contributed to increasing the number of patients with effective control of cancer pain. The Guidelines for Cancer Pain Relief established by the World Health Organization (WHO) have been useful in emphasizing the effectiveness of oral morphine as a mainstay of cancer pain treatment. Although the analgesic “ladder” drew attention to the importance of using opioids of increasing potency and adding adjuvant therapies as necessary, the strategy today is to tailor the ingredients of a multimodal oral regimen to each patient's requirements at a particular stage of the disease. Several algorithms exist for the treatment of cancer pain, including the WHO Cancer Pain Ladder and the Agency for Healthcare Policy and Research (AHCPR) and National Cancer Care Network (NCCN) cancer pain treatment guidelines. However, 10%–20% of patients will require more intensive measures to control pain, particularly in the terminal phases of their illness. Treatment options include primary therapies such as radiotherapy, chemotherapy, and surgery to reduce pain in specific cases; parenteral or spinal administration of analgesic agents; neurolytic blocks; and surgical neuroablative procedures. In a prospective study of 2118 patients with cancer pain managed according to WHO guidelines, neuraxial analgesic administration (epidural and intrathecal) was used in 3% of the patients.

Type
Chapter
Information
Cancer Pain
Assessment and Management
 , pp. 287 - 312
Publisher: Cambridge University Press
Print publication year: 2009

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References

,World Health Organization. Cancer pain relief. Geneva: World Health Organization, 1986.Google Scholar
Zech, DFJ, Grond, S, Lynch, J, et al. Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76, 1995.CrossRefGoogle ScholarPubMed
Burton, AW, Rajagopal, A, Shah, HN et al. Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med 5:239–47, 2004.CrossRefGoogle ScholarPubMed
Ferrante, FM, Bedder, M, Caplan, RA, et al. Practice guidelines for cancer pain management. Anesthesiology 84:1243, 1996.Google Scholar
Mercadante, S. Problems of long-term spinal opioid treatment in advanced cancer patients. Pain 79:1–13, 1999.CrossRefGoogle ScholarPubMed
Swarm, RA, Cousins, MJ. Anaesthetic techniques for pain control. In: Doyle, D, Hanks, G, MacDonald, N, eds. Oxford textbook of palliative medicine. Oxford: Oxford Medical Publications, 1993: pp 204–21.Google Scholar
Gildenberg, PL. Administration of narcotics in cancer pain. Stereotact Funct Neurosurg 59:1–8, 1992.CrossRefGoogle ScholarPubMed
Krames, ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 8:36–46, 1993.CrossRefGoogle ScholarPubMed
Smith, TJ, Staats, PS, Deer, T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncology 20:4040–9, 2002.CrossRefGoogle Scholar
Smith, TJ, Coyne, PJ, Staats, PS, et al. An implantable drug delivery system (IDDS) for refractory cancer pain provides sustained pain control, less drug-related toxicity, and possibly better survival compared with comprehensive medical management (CMM). Ann Oncol 16:825–33, 2005.CrossRefGoogle Scholar
Cousins, MJ, Veering, BT. Epidural neural blockade. In: Cousins, MJ, Bridenbaugh, PO, eds. Neural blockade in clinical anesthesia and pain management, 3rd ed. Philadelphia: Lippincott-Raven, 1998, pp 243–322.Google Scholar
Carr, DB, Cousins, MJ. Spinal route of analgesia: opioids and future options. In: Cousins MJ, Bridenbaugh PO, eds. Neural blockade in clinical anesthesia and pain management, 3rd ed. Philadelphia: Lippincott-Raven, 1998, pp 915–83.Google Scholar
Ballantyne, JC, Carr, DB, Berkey, CS, et al. Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Reg Anesth 21:542–56, 1996.Google Scholar
Yaksh, TL, Rudy, TA. Analgesia mediated by a direct spinal action of narcotics. Science 192:1357–8, 1976.CrossRefGoogle ScholarPubMed
Wang, JK, Nauss, , Thomas, JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 50:149–51, 1979.CrossRefGoogle ScholarPubMed
Cousins, MJ, Mather, , Glynn, CJ, et al. Selective spinal analgesia. Lancet 1:1141–2, 1979.CrossRefGoogle ScholarPubMed
Cousins, MJ, Mather, . Intrathecal and epidural administration of opioids. Anesthesiology 61:276–310, 1984.Google ScholarPubMed
Ballantyne, JC, Carwood, CM. Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev CD005178, 2005.CrossRefGoogle Scholar
Max, MB, Inturissi, CE, Kaiko, RF, et al. Epidural and intrathecal opiates: cerebrospinal fluid and plasma profiles in patients with chronic cancer pain. Clin Pharmacol Ther 38:631–41, 1985.CrossRefGoogle ScholarPubMed
Nordberg, G, Hedner, T, Mellstrand, T, Dahlstrom, B. Pharmacokinetic aspects of epidural morphine analgesia. Anesthesiology 58:545–51, 1983.CrossRefGoogle ScholarPubMed
Gourlay, GK, Cherry, DA, Cousins, MJ. Cephalad migration of morphine in CSF following lumbar epidural administration in patients with cancer pain. Pain 23:317–26, 1985.CrossRefGoogle ScholarPubMed
Brose, WG, Tanelian, DL, Brodsky, JB, et al. CSF and blood pharmacokinetics of hydromorphone and morphine following lumbar epidural administration. Pain 45:11–15, 1991.CrossRefGoogle ScholarPubMed
Glynn, CJ, Mather, , Cousins, MJ, et al. Peridural meperidine in humans: analgesic response, pharmacokinetics and transmission into CSF. Anesthesiology 55:520–6, 1981.CrossRefGoogle ScholarPubMed
Sjostrom, S, Hartvig, P, Persson, P, Tamsen, A. Pharmacokinetics of epidural morphine and meperidine in man. Anesthesiology 67:877, 1987.CrossRefGoogle Scholar
Guinard, JP, Carpenter, RL, Chassot, PG. Epidural and intravenous fentanyl produce equivalent effects during major surgery. Anesthesiology 82:377–82, 1995.CrossRefGoogle ScholarPubMed
Coda, BA, Brown, MC, Schaffer, RL, et al. A pharmacokinetic approach to resolving spinal and systemic contributions to epidural alfentanil analgesia and side-effects. Pain 62:329–37, 1995.CrossRefGoogle ScholarPubMed
Dickenson, AH. Where and how do opioids work? In: Gebhart, GF, Hammond, DL, Jensen, TS, eds. Progress in pain research and management, vol 2. Proceedings of the 7th World Congress on Pain. Seattle: IASP Publications, 1993, pp 525–52.Google Scholar
Suzuki, R, Chapman, V, Dickenson, AH. The effectiveness of spinal and systemic morphine on rat dorsal horn neuronal responses in the spinal nerve ligation model of neuropathic pain. Pain 80:215–28, 1999.CrossRefGoogle ScholarPubMed
Kalso, E, Heiskanen, T, Rantio, M, et al. Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study. Pain 67:443–9, 1996.CrossRefGoogle ScholarPubMed
Devulder, J, Ghys, L, Dhondt, W, Rolly, G. Spinal analgesia in terminal care: risk versus benefit. J Pain Symptom Manage 9:75–81, 1994.CrossRefGoogle ScholarPubMed
DuPen, SL, Williams, AR. The dilemma of conversion from systemic to epidural morphine: a proposed conversion tool for treatment of cancer pain. Pain 56:113–18, 1994.CrossRefGoogle Scholar
Anderson, VC, Cooke, B, Burchiel, KJ. Intrathecal hydromorphone for chronic nonmalignant pain: a retrospective study. Pain Med 2:287–97, 2001.CrossRefGoogle ScholarPubMed
DuPen, S, DuPen, A, Hillyer, J. Intrathecal hydromorphone for intractable nonmalignant pain: a retrospective study. Pain Med 7:10–15, 2006.CrossRefGoogle Scholar
Carl, P, Crawford, ME, Ravlo, O, Bach, V. Long term treatment with epidural opioids. A retrospective study comprising 150 patients treated with morphine chloride and buprenorphine. Anaesthesia 41:32–8, 1986.CrossRefGoogle Scholar
Samuelsson, H, Malmberg, F, Eriksson, M, Hedner, T. Outcomes of epidural morphine treatment in cancer pain: nine years of clinical experience. J Pain Symptom Manage 10:105–12, 1995.CrossRefGoogle ScholarPubMed
Krames, ES, Wilkie, DJ, Gershow, J. Intrathecal D-Ala2-D-Leu5-enkephalin (DADL) restores analgesia in a patient analgetically tolerant to intrathecal morphine sulfate. Pain 24:205–9, 1986.CrossRefGoogle Scholar
Dirig, DM, Yaksh, TL. Differential right shifts in the dose-response curve for intrathecal morphine and sufentanil as a function of stimulus intensity. Pain 62:321–8, 1995.CrossRefGoogle ScholarPubMed
Leon-Casasola, OA, Lema, MJ. Epidural bupivacaine/sufentanil therapy for postoperative pain control in patients tolerant to opioid and unresponsive to epidural bupivacaine/morphine. Anesthesiology 80:303–9, 1994.CrossRefGoogle ScholarPubMed
Hassenbusch, SM, Portenoy, RK. Current practices in intraspinal therapy – a survey of clinical trends and decision making. J Pain Symptom Manage 20:S4–11, 2000.CrossRefGoogle ScholarPubMed
Deer, T, Krames, ES, Hassenbusch, SJ, et al. Polyanalgesic Consensus Conference 2007: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 10:300–28, 2007.CrossRefGoogle ScholarPubMed
Rauck, RL, Cherry, D, Boyer, MF, et al. Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. J Pain 4:441–7, 2003.CrossRefGoogle ScholarPubMed
Paice, JA, Penn, RD, Shott, S. Intraspinal morphine for chronic pain: a retrospective, multicenter study. J Pain Symptom Manage 11:71–80, 1996.CrossRefGoogle ScholarPubMed
Johansen, MJ, Satterfield, WC, Baze, WB et al. Continuous intrathecal infusion of hydromorphone: safety in the sheep model and clinical implications. Pain Med 5:14–25, 2004.CrossRefGoogle ScholarPubMed
Waara-Wolleat, KL, Hildebrand, KR, Stewart, GR. A review of intrathecal fentanyl and sufentanil for the treatment of chronic pain. Pain Med 7:251–9, 2006.CrossRefGoogle ScholarPubMed
Ahmed, SU, Martin, NM, Chang, Y. Patient selection and trial methods for intraspinal drug delivery for chronic pain: A national survey. Neuromodulation 8:112–120, 2005.CrossRefGoogle ScholarPubMed
Ngan Kee, WD. Intrathecal pethidine: pharmacology and clinical applications. Anaesth Intens Care 26:137–46, 1998.Google ScholarPubMed
Vranken, JH, Vegt, MH, Kan, HJM, Kruis, MR. Plasma concentrations of meperidine and normeperidine following continuous intrathecal meperidine in patients with neuropathic cancer pain. Acta Anaesth Scand 49:665–70, 2005.CrossRefGoogle ScholarPubMed
Kaiko, RF, Foley, KM, Grabinski, PY, et al. Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurol 13:180–5, 1983.CrossRefGoogle ScholarPubMed
Shir, Y, Shapira, SS, Shenkman, Z, et al. Continuous epidural methadone treatment for cancer pain. Clin J Pain 7:339–41, 1991.CrossRefGoogle ScholarPubMed
Jacobsen, L, Chabal, C, Brody, MC, et al. Intrathecal methadone and morphine for postoperative analgesia: a comparison of efficacy, duration and side-effects. Anesthesiology 70:742–6, 1989.CrossRefGoogle Scholar
Mironer, YE, Tollison, CD. Methadone in the intrathecal treatment of chronic non-malignant pain resistant to other neuroaxial agents: the first experience. Neuromodulation 4:25–31, 2001.CrossRefGoogle Scholar
Arner, S, Rawal, N, Gustafsson, LL. Clinical experience of longterm treatment with epidural and intrathecal opioids – a nationwide survey. Acta Anaesth Scand 32:253–9, 1988.CrossRefGoogle Scholar
Brazenor, GA. Long term intrathecal administration of morphine: a comparison of bolus injection via reservoir with continuous infusion by implanted pump. Neurosurgery 21:484–91, 1987.CrossRefGoogle ScholarPubMed
Crawford, ME, Anderses, HB, Augustenborg, G, et al. Pain treatment on an outpatient basis utilizing extradural opiates. A Danish multicentre study comprising 105 patients. Pain 16:41–7, 1983.CrossRefGoogle ScholarPubMed
DuPen, SL, Peterson, DG, Bogosian, AC, et al. A new permanent exteriorized epidural catheter for narcotic self-administration to control cancer pain. Cancer 59:986–93, 1987.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Krames, ES, Gershow, J, Glassberg, A, et al. Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders. Cancer 56:696–702, 1985.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Malone, BT, Beye, R, Walker, J. Management of pain in the terminally ill by administration of epidural narcotics. Cancer 55:438–40, 1985.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Lazorthes, Y, Veride, JC, Bastide, R, et al. Spinal versus intraventricular chronic opiate administration with implantable drug delivery devices for cancer pain. Appl Neurophysiol 48:234–41, 1985.Google ScholarPubMed
Coombs, DW, Maurer, LH, Saunders, RL, Gaylor, M. Outcomes and complications of continuous intraspinal narcotic analgesia for cancer pain control. J Clin Oncol 2:1414–20, 1984.CrossRefGoogle ScholarPubMed
Scherens, A, Kagel, T, Zenz, M, Maier, C. Long-term respiratory depression induced by intrathecal morphine treatment for chronic neuropathic pain. Anesthesiology 105:431–3, 2006.CrossRefGoogle ScholarPubMed
Bromage, PR, Camporesi, EM, Durant, PAC, Nielsen, CH. Rostral spread of epidural morphine. Anesthesiology 56:431–6, 1982.CrossRefGoogle ScholarPubMed
Brownridge, P. Epidural and intrathecal opiates for postoperative pain relief. Anaesthesia 38:74, 1983.CrossRefGoogle ScholarPubMed
Donadoni, R, Rolly, G, Noorduin, H, Vanden Bussche, G. Epidural sufentanil for postoperative pain relief. Anaesthesia 40:634, 1985.CrossRefGoogle ScholarPubMed
Welchew, EA. The optimum concentration for epidural fentanyl. A randomised double-blind comparison with and without 1:200000 adrenaline. Anaesthesia 38:1037–41, 1983.CrossRefGoogle Scholar
Hogan, Q, Haddox, JD, Abram, S, et al. Epidural opiates and local anesthetics for the management of cancer pain. Pain 46:271–9, 1991.CrossRefGoogle ScholarPubMed
De Conno, F, Caraceni, A, Martini, C, et al. Hyperalgesia and myoclonus with intrathecal infusion of high-dose morphine. Pain 47:337–9, 1991.CrossRefGoogle ScholarPubMed
Parisod, E, Siddall, PJ, Viney, M, et al. Allodynia after acute intrathecal morphine administration in a patient with neuropathic pain after spinal cord injury. Anesth Analg 97:183–6, 2003.CrossRefGoogle Scholar
Yaksh, TL, Harty, GJ, Onofrio, BM. High doses of spinal morphine produce a nonopiate receptor-mediated hyperesthesia: clinical and theoretic implications. Anesthesiology 64:590–7, 1986.CrossRefGoogle ScholarPubMed
Portenoy, RK, Savage, SR. Clinical realities and economic considerations: special therapeutic issues in intrathecal therapy – tolerance and addiction. J Pain and Symptom Manage 14 S27–35, 1997.CrossRefGoogle ScholarPubMed
Abs, R, Verhelst, J, Maeyaert, J, et al. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab 85:2215–22, 2000.CrossRefGoogle ScholarPubMed
Finch, PM, Roberts, LJ, Price, L, et al. Hypogonadism in patients treated with intrathecal morphine. Clin J Pain 16:251–4, 2000.CrossRefGoogle ScholarPubMed
North, RB, Cutchis, PN, Epstein, JA, Long, DM. Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. Neurosurgery 29:778–84, 1991.CrossRefGoogle ScholarPubMed
Allen, JW, Horais, KA, Tozier, NA, et al. Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs: a combined magnetic resonance imaging and histopathology investigation. Anesthesiology 105:581–9, 2006.CrossRefGoogle ScholarPubMed
Coffey, RJ, Burchiel, K. Inflammatory mass lesions associated with intrathecal drug infusion catheters: report and observations on 41 patients. Neurosurgery 50:78–87, 2002.Google ScholarPubMed
Yaksh, TL, Hassenbusch, S, Burchiel, K, et al. Inflammatory masses associatedwith intrathecal drug infusion: a review of preclinical evidence and human data. Pain Med 3:300–12, 2002.CrossRefGoogle Scholar
Deer, TR. A prospective analysis of intrathecal granuloma in chronic pain patients; a review of the literature and report of a surveillance study. Pain Physician 7:225–8, 2004.Google ScholarPubMed
Hassenbusch, S, Burchiel, K, Coffey, RJ, et al. Management of intrathecal catheter-tip inflammatory masses: a consensus statement. Pain Med 3:313–23, 2002.CrossRefGoogle ScholarPubMed
Murphy, PM, Skouvaklis, , Amadeo, RJ, et al. Intrathecal catheter granuloma associated with isolated baclofen infusion. Anesth Analg 102:848–52, 2006.CrossRefGoogle ScholarPubMed
Deer, TR, Raso, LJ, Garten, TG. Inflammatory mass of an intrathecal catheter in patients receiving baclofen as a sole agent: a report of two cases and a review of the identification and treatment of the complication. Pain Med 8:259–62, 2007.CrossRefGoogle Scholar
Aldrete, JA, Couto da Silva, JM. Leg edema from intrathecal opiate infusions. Eur J Pain 4:361–5, 2000.CrossRefGoogle ScholarPubMed
Kawamata, T, Omote, K, Toriyabe, M, et al. Intracerebroventricular morphine produces antinociception by evoking gamma-aminobutyric acid release through activation of 5-hydroxytryptamine 3 receptors in the spinal cord. Anesthesiology 96:1175–82, 2002.CrossRefGoogle ScholarPubMed
Cramond, T, Stuart, G. Intraventricular morphine for intractable pain of advanced cancer. J Pain Symptom Manage 8:465–73, 1993.CrossRefGoogle ScholarPubMed
Leavens, ME, Stratton Hill, C, Cech, DA, et al. Intrathecal and intraventricular morphine for pain in cancer patients: initial study. J Neurosurg 56:241–5, 1982.CrossRefGoogle ScholarPubMed
Lenzi, A, Galli, G, Gandolfini, M, Marini, G. Intraventricular morphine in paraneoplastic painful syndrome of the cervicofacial region: experience in thirty eight cases. Neurosurgery 17:6–11, 1985.CrossRefGoogle ScholarPubMed
Lobato, RD, Madrid, JL, Fatela, LV, et al. Analgesia elicited by low-dose intraventricular morphine in terminal cancer patients. In: Fields, HL, ed. Advances in pain research and therapy, vol 9. New York: Raven Press, 1985, pp 673–81.Google Scholar
Nurchi, GN. Use of intraventricular and intrathecal morphine in intractable pain associated with cancer. Neurosurgery 15:801–3, 1984.Google ScholarPubMed
Obbens, EA, Stratton Hill, C, Leavens, ME, et al. Intraventricular morphine administration for control of chronic cancer pain. Pain 28:61–8, 1987.CrossRefGoogle ScholarPubMed
Smith, MT, Wright, AWE, Williams, BE, et al. Cerebrospinal fluid and plasma concentrations of morphine, morphine-3-glucuronide, and morphine-6-glucuronide in patients before and after initiation of intracerebroventricular morphine for cancer pain management. Anesth Analg 88:109–16, 1999.Google ScholarPubMed
Sandouk, P, Serrie, A, Urtizberea, M, et al. Morphine pharmacokinetics and pain assessment after intracerebroventricular administration in patients with terminal cancer. Clin Pharmacol Ther 49:442–8, 1991.CrossRefGoogle ScholarPubMed
Dagi, TF, Chilton, J, Caputy, A, Won, D. Long-term intermittent percutaneous administration of epidural and intrathecal morphine for pain of malignant origin. Am Surg 52:155–8, 1986.Google ScholarPubMed
Covino, BG, Wildsmith, JAW. Clinical pharmacology of local anesthetic agents. In: Cousins, MJ, Bridenbaugh, PO, eds. Neural blockade in clinical anesthesia and pain management, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1998, pp 97–128.Google Scholar
Tucker, GT, Mather, . Properties, absorption, and disposition of local anaesthetic agents. In: Cousins, MJ, Bridenbaugh, PO, eds. Neural blockade in clinical anesthesia and management of pain, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1998, pp 55–95.Google Scholar
Nagy, I, Woolf, CJ. Lignocaine selectively reduces C fibre-evoked neuronal activity in rat spinal cord in vitro by decreasing N-methyl-d-aspartate and neurokinin receptor-mediated post-synaptic depolarizations; implications for the development of novel centrally acting analgesics. Pain 64:59–70, 1996.CrossRefGoogle ScholarPubMed
Brose, WB, Cousins, MJ. Subcutaneous lidocaine for treatment of neuropathic cancer pain. Pain 45:145–8, 1991.CrossRefGoogle ScholarPubMed
Hildebrand, KR, Elsberry, , Deer, TR. Stability, compatibility, and safety of intrathecal bupivacaine administered chronically via an implantable delivery system. Clin J Pain 17:239–44, 2001.CrossRefGoogle ScholarPubMed
Deer, TR, Caraway, DL, Kim, CK, et al. Clinical experience with intrathecal bupivacaine in combination with opioid for the treatment of chronic pain related to failed back surgery syndrome and metastatic cancer pain of the spine. Spine J 2:274–8, 2002.CrossRefGoogle Scholar
Deer, TR, Serfaini, M, Buchser, E, et al. Intrathecal bupivacaine for chronic pain: a review of current knowledge. Neuromodulation 5:196–207, 2002.CrossRefGoogle ScholarPubMed
DuPen, SL, Kharasch, ED, Williams, A, et al. Chronic epidural bupivacaine-opioid infusion in intractable cancer pain. Pain 49:293–300, 1992.CrossRefGoogle Scholar
Mercadante, S. Intrathecal morphine and bupivacaine in advanced cancer pain patients implanted at home. J Pain Symptom Manage 9:201–7, 1994.CrossRefGoogle ScholarPubMed
Sjoberg, M, Nitescu, P, Appelgren, L, Curelaru, I. Long-term intrathecal morphine and bupivacaine in patients with refractory cancer pain. Results from a morphine:bupivacaine dose regimen of 0.5:4.75 mg/ml. Anesthesiology 80:284–97, 1994.CrossRefGoogle ScholarPubMed
Van Dongen, RT, Crul, BJ, De Bock, M. Long-term intrathecal infusion of morphine and morphine/bupivacaine mixtures in the treatment of cancer pain: a retrospective analysis of 51 cases. Pain 55:119–23, 1993.CrossRefGoogle ScholarPubMed
DuPen, SL, Ramsey, DH. Compounding local anesthetics and narcotics for epidural analgesia in cancer out-patients. Anesthesiology 69:A405, 1988.CrossRefGoogle Scholar
DuPen, SL, Williams, AR. Management of patients receiving combined epidural morphine and bupivacaine for the treatment of cancer pain. J Pain Symptom Manage 7:125–7, 1992.CrossRefGoogle Scholar
Sjoberg, M, Appelgren, L, Einarsson, S, et al. Long-term intrathecal morphine and bupivacaine in “refractory” cancer pain. 1. Results from the first series of 52 patients. Acta Anaesth Scand 35:30–43, 1991.CrossRefGoogle ScholarPubMed
Nitescu, P, Dahm, P, Appelgren, L, Curelaru, I. Continuous infusion of opioid and bupivacaine by externalized intrathecal catheters in long-term treatment of “refractory” nonmalignant pain. Clin J Pain 14:17–28, 1998.CrossRefGoogle ScholarPubMed
Van Dongen, RT, Crul, BJ, Egmond, J. Intrathecal coadministration of bupivacaine diminishes morphine dose progression during long-term intrathecal infusion in cancer patients. Clin J Pain 15:166–72, 1999.CrossRefGoogle ScholarPubMed
Mironer, YE, Haasis, JC, Chapple, I, et al. Efficacy and safety of intrathecal opioid/bupivacaine mixture in chronic nonmalignant pain: a double blind, randomized, crossover, multicentre study by the National Forum of Independent Pain Clinicians. Neuromodulation 5:208–13, 2002.CrossRefGoogle ScholarPubMed
Dahm, P, Nitescu, P, Appelgren, L, Curelaru, I. Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps. Clin J Pain 14:4–16, 1998.CrossRefGoogle ScholarPubMed
Bennet, G, Serafini, M, Burchiel, K, et al. Evidence-based review of the literature on intrathecal delivery of pain medication. J Pain and Symptom Manage 20:S12–36, 2000.CrossRefGoogle Scholar
Scott, DA, Emanuelsson, BM, Mooney, PH, et al. Pharmacokinetics and efficacy of long-term epidural ropivacaine infusion for postoperative analgesia. Anesth Analg 85:1322–30, 1997.CrossRefGoogle ScholarPubMed
Mercadante, S, Calderone, L, Barresi, L. Intrathecal ropivacaine in cancer pain. Reg Anaesth Pain Med 23:621, 1998.CrossRefGoogle ScholarPubMed
Dahm, P, Lundborg, C, Janson, M, et al. Comparison of 0.5% intrathecal bupivacaine with 0.5% intrathecal ropivacaine in the treatment of refractory cancer and noncancer pain conditions: results from a prospective, crossover, double-blind, randomized study. Reg Anesth Pain Med 25:480–7, 2000.Google ScholarPubMed
Yaksh, TL, Malmberg, AB. Interaction of spinal modulatory receptor systems. In: Fields, HL, Liebeskind, JC, eds. Progress in pain management and research, vol. 1. Seattle: IASP Press, 1994, pp 151–71.Google Scholar
Hassenbusch, SJ, Portenoy, RK, Cousins, MJ, et al. Polyanalgesic Consensus Conference 2003: an update on the management of pain by intraspinal drug delivery – report of an expert panel. J Pain Symptom Manage 27:540–63, 2004.CrossRefGoogle ScholarPubMed
Goudas, LC. Clonidine. Curr Opin Anesth 8:455, 1995.CrossRefGoogle Scholar
Eisenach, JC, De Kock, M, Klimscha, W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology 85:655–74, 1996.CrossRefGoogle Scholar
Goudas, LC, Carr, DB, Filos, KS, et al. The spinal clonidine – opioid analgesic interaction: from laboratory animals to the postoperative ward. A literature review of preclinical and clinical evidence. Analgesia 3:277–90, 1998.CrossRefGoogle Scholar
Yaksh, TL, Reddy, S. Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha adrenergic agonists and baclofen. Anesthesiology 54:451–67, 1981.CrossRefGoogle ScholarPubMed
Coombs, DW, Saunders, RL, Lachance, D, et al. Intrathecal morphine tolerance: use of intrathecal clonidine, DADLE, and intraventricular morphine. Anesthesiology 62:358–63, 1985.CrossRefGoogle ScholarPubMed
Ossipov, MH, Suarez, LJ, Spaulding, TC. Antinociceptive interactions between alpha-adrenergic and opiate agonists at the spinal level in rodents. Anesth Analg 68:194–200, 1989.CrossRefGoogle Scholar
Essen, EJ, Bovill, JG, Ploeger, EJ, Beerman, H. Intrathecal morphine and clonidine for control of intractable cancer pain. A case report. Acta Anaesth Belg 39:109–12, 1988.Google ScholarPubMed
Coombs, DW, Saunders, RL, Fratkin, JD, et al. Continuous intrathecal hydromorphone and clonidine for intractable cancer pain. J Neurosurg 64:890–4, 1986.CrossRefGoogle ScholarPubMed
Eisenach, JC, Rauck, RL, Buzzanell, C, Lysak, SZ. Epidural clonidine analgesia for intractable cancer pain: phase 1. Anesthesiology 71:647–52, 1989.CrossRefGoogle Scholar
Eisenach, JC, DuPen, S, Dubois, M, et al. Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group. Pain 61:391–9, 1995.CrossRefGoogle ScholarPubMed
Lee, Y-W, Yaksh, TL. Analysis of drug interaction between intrathecal clonidine and MK-801 in peripheral neuropathic pain rat model. Anesthesiology 82:741–8, 1995.CrossRefGoogle ScholarPubMed
Hassenbusch, SJ, Gunes, S, Wachsman, S, Willis, KD. Intrathecal clonidine in the treatment of intractable pain: a phase I/II study. Pain Med 3:85–91, 2002.CrossRefGoogle ScholarPubMed
Siddall, PJ, Molloy, AR, Walker, S, et al. The efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury. Anesth Analg 91:1493–8, 2000.CrossRefGoogle ScholarPubMed
Eisenach, J, Detweiler, D, Hood, D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 78:277–87, 1993.CrossRefGoogle ScholarPubMed
Filos, KS, Goudas, LC, Patroni, O, Polyzou, V. Hemodynamic and analgesic profile after intrathecal clonidine in humans. Anesthesiology 81:591–601, 1994.CrossRefGoogle ScholarPubMed
Mendez, R, Eisenach, JC, Kashtan, K. Epidural clonidine after cesarean section. Anesthesiology 73:848–52, 1990.CrossRefGoogle ScholarPubMed
Eisenach, JC, Lysak, SZ, Viscomi, CM. Epidural clonidine analgesia following surgery: phase 1. Anesthesiology 71:640–6, 1989.CrossRefGoogle Scholar
Perren, F, Buchser, E, Chédel, D, et al. Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain. Pain 109:189–94, 2004.CrossRefGoogle ScholarPubMed
Kohno, T, Kumamoto, E, Baba, H, et al. Actions of midazolam on GABAergic transmission in substantia gelatinosa neurons of adult rat spinal cord slices. Anesthesiology 92:507–15, 2000.CrossRefGoogle ScholarPubMed
Goodchild, CS, Noble, J. The effects of intrathecal midazolam in the rat: evidence of spinally mediated analgesia. Br J Anaesth 59:1563–70, 1987.CrossRefGoogle ScholarPubMed
Plummer, JL, Cmielewski, PL, Gourlay, GK, et al. Antinociceptive and motor effects of intrathecal morphine combined with intrathecal clonidine, noradrenaline, carbachol or midazolam in rats. Pain 49:145–52, 1992.CrossRefGoogle ScholarPubMed
Hara, K, Saito, Y, Kirihara, Y, et al. The interaction of antinociceptive effects of morphine and GABA receptor agonists within the rat spinal cord. Anesth Analg 89:422–7, 1999.Google ScholarPubMed
Wang, C, Chakrabarti, MK, Whitwam, JG. Synergism between the antinociceptive effects of intrathecal midazolam and fentanyl on both A delta and C somatosympathetic reflexes. Neuropharmacology 32:303–5, 1993.CrossRefGoogle ScholarPubMed
Nishiyama, T, Gyermek, L, Lee, C, et al. Analgesic interaction between intrathecal midazolam and glutamate receptor antagonists on thermal-induced pain in rats. Anesthesiology 91:531–7, 1999.CrossRefGoogle ScholarPubMed
Aguilar, JL, Espachs, P, Roca, G, et al. Difficult management of pain following sacrococcygeal chordoma: 13 months of subarachnoid infusion. Pain 59:317–20, 1994.CrossRefGoogle ScholarPubMed
Barnes, RK, Rosenfeld, JV, Fennessy, SS, Goodchild, CS. Continuous subarachnoid infusion to control severe cancer pain in an ambulant patient. Med J Aust 161:549–51, 1994.Google Scholar
Svensson, BA, Welin, M, Gordh, T, Westman, J. Chronic subarachnoid midazolam (Dormicum) in the rat. Morphologic evidence of spinal cord neurotoxicity. Reg Anesth 20:426–34, 1995.Google ScholarPubMed
Malinovsky, JM, Cozian, A, Lepage, JY, et al. Ketamine and midazolam neurotoxicity in the rabbit. Anesthesiology 75:91–7, 1991.CrossRefGoogle ScholarPubMed
Erdine, S, Yucel, A, Ozyalcin, S, et al. Neurotoxicity of midazolam in the rabbit. Pain 80:419–23, 1999.CrossRefGoogle ScholarPubMed
Bozkurt, P, Tunali, Y, Kaya, G, Okar, I. Histological changes following epidural injection of midazolam in the neonatal rabbit. Paediatr Anaesth 7:385–9, 1997.CrossRefGoogle ScholarPubMed
Yaksh, TL, Allen, JW. The use of intrathecal midazolam in humans: a case study of process. Anesth Analg 98:1536–45, 2004.CrossRefGoogle ScholarPubMed
Johansen, MJ, Gradert, TL, Satterfield, WC, et al. Safety of continuous intrathecal midazolam infusion in the sheep model. Anesth Analg 98:1528–35, 2004.CrossRefGoogle ScholarPubMed
Schoeffler, P, Auroy, P, Bazin, JE, et al. Subarachnoid midazolam: histologic study in rats and report of its effect on chronic pain in humans. Reg Anesth 16:329–32, 1991.Google ScholarPubMed
Bahar, M, Cohen, ML, Grinshpoon, Y, et al. An investigation of the possible neurotoxic effects of intrathecal midazolam combined with fentanyl in the rat. Eur J Anaesth 15:695–701, 1998.CrossRefGoogle ScholarPubMed
Serrao, JM, Mackenzie, JM, Goodchild, CS, Gent, JP. Intrathecal midazolam in the rat: an investigation of possible neurotoxic effects. Eur J Anaesth 75:115–22, 1990.Google Scholar
Tucker, AP, Lai, C, Nadeson, R, Goodchild, CS. Intrathecal midazolam I: a cohort study investigating safety. Anesth Analg 98:1512–20, 2004.CrossRefGoogle ScholarPubMed
Canavero, S, Bonicalzi, V, Clemente, M. No neurotoxicity from long-term (>5 years) intrathecal infusion of midazolam in humans [letter]. J Pain Symptom Manage 32:1–2, 2006.CrossRefGoogle Scholar
Rainov, NG, Heidecke, V, Burkert, W. Long-term intrathecal infusion of drug combinations for chronic back and leg pain. J Pain Symptom Manage 22:862–71, 2001.CrossRefGoogle ScholarPubMed
Borg, PA, Krijnen, HJ. Long-term intrathecal administration of midazolam and clonidine. Clin J Pain 12:63–8, 1996.CrossRefGoogle ScholarPubMed
Cousins, MJ, Miller, RD. Intrathecal midazolam: an ethical editorial dilemma [editorial]. Anesth Analg 98:1507–8, 2004.CrossRefGoogle Scholar
Yaksh, TL, Allen, JW. Preclinical insights into the implementation of intrathecal midazolam: a cautionary tale. Anesth Analg 98:1509–11, 2004.CrossRefGoogle ScholarPubMed
Coffey, RJ, et al. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg 78:226–32, 1993.CrossRefGoogle ScholarPubMed
Zuniga, RE, Schlicht, CR, Abram, SE. Intrathecal baclofen is analgesic in patients with chronic pain. Anesthesiology 92:876–80, 2000.CrossRefGoogle ScholarPubMed
Slonimski, M, Abram, SE, Zuniga, RE. Intrathecal baclofen in pain management. Reg Anesth Pain Med 29:269–76, 2004.CrossRefGoogle ScholarPubMed
Joo, G, Horvath, G, Klimscha, W, et al. The effects of ketamine and its enantiomers on the morphine- or dexmedetomidine-induced antinociception after intrathecal administration in rats. Anesthesiology 93:231–41, 2000.CrossRefGoogle ScholarPubMed
Dickenson, AH, Sullivan, AF, Stanfa, LC, McQuay, HJ. Dextromethorphan and levorphanol on dorsal horn nociceptive neurones in the rat. Neuropharmacology 30:1303–8, 1991.CrossRefGoogle ScholarPubMed
Mao, J, Price, DD, Hayes, RL, et al. Intrathecal treatment with dextrorphan or ketamine potently reduces pain-related behaviours in a rat model of peripheral mononeuropathy. Brain Res 605:164–8, 1993.CrossRefGoogle ScholarPubMed
Hawksworth, C, Serpell, M. Intrathecal anesthesia with ketamine. Reg Anesth Pain Med 23:283–8, 1998.Google ScholarPubMed
Kathirvel, S, Sadhasivam, S, Saxena, A, et al. Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia. Anaesthesia 55:899–904, 2000.CrossRefGoogle ScholarPubMed
Kawana, Y, Sato, H, Shimada, H, et al. Epidural ketamine for postoperative pain relief after gynecologic operations: a double-blind study and comparison with epidural morphine. Anesth Analg 66:735–8, 1987.CrossRefGoogle ScholarPubMed
Yamamoto, T, Yaksh, TL. Studies on the spinal interaction of morphine and the NMDA antagonist MK-801 on the hyperesthesia observed in a rat model of sciatic mononeuropathy. Neurosci Lett 135:67–70, 1992.CrossRefGoogle Scholar
Wong, CS, Liaw, WJ, Tung, CS, et al. Ketamine potentiates analgesic effect of morphine in postoperative epidural pain control. Reg Anesth 21:534–41, 1996.Google ScholarPubMed
Miyamoto, H, Saito, Y, Kirihara, Y, et al. Spinal coadministration of ketamine reduces the development of tolerance to visceral as well as somatic antinociception during spinal morphine infusion. Anesth Analg 90:136–41, 2000.CrossRefGoogle ScholarPubMed
Shimoyama, N, Shimoyama, M, Inturrisi, CE, Elliott, KJ. Ketamine attenuates and reverses morphine tolerance in rodents. Anesthesiology 85:1357–66, 1996.CrossRefGoogle ScholarPubMed
Dunbar, S, Yaksh, TL. Concurrent spinal infusion of MK801 blocks spinal tolerance and dependence induced by chronic intrathecal morphine in the rat. Anesthesiology 84:1177–88, 1996.CrossRefGoogle ScholarPubMed
Lauretti, GR, Gomes, JM, Reis, MP, Pereira, NL. Low doses of epidural ketamine or neostigmine, but not midazolam, improve morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth 11:663–8, 1999.CrossRefGoogle Scholar
Yang, CY, Wong, CS, Chang, JY, Ho, ST. Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain. Can J Anaesth 43:379–83, 1996.CrossRefGoogle ScholarPubMed
Karpinski, N, Dunn, J, Hansen, L, Masliah, E. Subpial vacuolar myelopathy after intrathecal ketamine: report of a case. Pain 73:103–5, 1997.CrossRefGoogle ScholarPubMed
Stotz, M, Oehen, HP, Gerber, H. Histological findings after long-term infusion of intrathecal ketamine for chronic pain: a case report. Pain Symptom Manage 18:223–8, 1999.CrossRefGoogle ScholarPubMed
Borgbjerg, FM, Svensson, BA, Frigast, C, Gordh, T. Histopathology after repeated intrathecal injections of preservative-free ketamine in the rabbit: a light and electron microscopic examination. Anesth Analg 79:105–11, 1994.CrossRefGoogle ScholarPubMed
Malinovsky, J-M, Lepage, J-Y, Cozian, A, et al. Is ketamine or its preservative responsible for neurotoxicity in the rabbit?Anesthesiology 78:109–15, 1993.CrossRefGoogle ScholarPubMed
Errando, CL, Sifre, C, Moliner, S, et al. Subarachnoid ketamine in swine – pathological findings after repeated doses: acute toxicity study. Reg Anesth Pain Med 24:146–52, 1999.Google ScholarPubMed
Vranken, JH, Vegt, MH, Kal, JE, Kruis, MR. Treatment of neuropathic cancer pain with continuous intrathecal administration of S (+)-ketamine. Acta Anaesthesiol Scand 48:249–52, 2004.CrossRefGoogle ScholarPubMed
Kozek, SA, Sator-Katzenschlager, S, Kress, HG. Intrathecal S(+)-ketamine in refractory neuropathic cancer pain [letter]. Pain 121:281, 2006.CrossRefGoogle Scholar
Vranken, JH, Troost, D, Wegener, JT, et al. Neuropathological findings after continuous intrathecal administration of S(+)-ketamine for the management of neuropathic cancer pain. Pain 117:231–5, 2005.CrossRefGoogle ScholarPubMed
Vranken, JH, Troost, D, deHaan, P et al. Severe toxic damage to the rabbit spinal cord after intrathecal administration of preservative-free S(+)-ketamine. Anesthesiology 105:813–18, 2006.CrossRefGoogle ScholarPubMed
Lynch, SS, Cheng, CM, Yee, JL. Intrathecal ziconotide for refractory chronic pain. Ann Pharmacother 40:1293–300, 2006.CrossRefGoogle ScholarPubMed
Malmberg, AB, Yaksh, TL. Effect of continuous intrathecal infusion of omega-conopeptides, N-type calcium channel blockers, on behavior and antinociception in the formalin and hot-plate tests in rats. Pain 60:83–90, 1995.CrossRefGoogle ScholarPubMed
Malmberg, AB, Yaksh, TL. Voltage-sensitive calcium channels in spinal nociceptive processing: blockade of N- and P-type channels inhibits formalin-induced nociception. J Neurosci 14:4882–90, 1994.CrossRefGoogle ScholarPubMed
White, DM, Cousins, MJ. Effect of subcutaneous administration of calcium channel blockers on nerve injury-induced hyperalgesia. Brain Res 801:50–8, 1998.CrossRefGoogle ScholarPubMed
Miljanich, GP. Ziconotide: neuronal calcium channel blocker for treating severe chronic pain. Curr Med Chem 11:3029–40, 2004.CrossRefGoogle ScholarPubMed
Wang, YX, Gao, D, Pettus, M, et al. Interactions of intrathecally administered ziconotide, a selective blocker of neuronal N-type voltage-sensitive calcium channels, with morphine on nociception. Pain 84:271–81, 2000.CrossRefGoogle ScholarPubMed
Wang, YX, Pettus, M, Gao, D et al. Effects of intrathecal administration of ziconotide, a selective neuronal N-type calcium channel blocker, on mechanical allodynia and heat hyperalgesia in a rat model of postoperative pain. Pain 84:151–8, 2000.CrossRefGoogle Scholar
Bowersox, SS, Gadbois, T, Singh, T, et al. Selective N-type neuronal voltage-sensitive calcium channel blocker, SNX-111, produces spinal antinociception in rat models of acute, persistent and neuropathic pain. J Pharmacol Exp Ther 279:1243–9, 1996.Google ScholarPubMed
Atanassoff, PG, Hartmannsgruber, MW, Thrasher, J, et al. Ziconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain. Reg Anesth Pain Med 25:274–8, 2000.Google ScholarPubMed
Brose, WG, Gutlove, DP, Luther, RR, et al. Use of intrathecal SNX-111, a novel N-type voltage-sensitive calcium channel blocker in the management of intractable brachial plexus avulsion pain. Clin J Pain 13:256–9, 1997.CrossRefGoogle ScholarPubMed
Staats, PS, Yearwood, T, Charapata, SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS. JAMA 291:63–70, 2004.CrossRefGoogle ScholarPubMed
Wallace, MS, Charapata, SG, Fisher, R, et al. Intrathecal ziconotide in the treatment of chronic nonmalignant pain: a randomized, double-blind, placebo-controlled clinical trial. Neuromodulation 9:75–86, 2006.CrossRefGoogle ScholarPubMed
Rauch, RL, Wallace, MS, Leong, MS, et al. A randomized, double-blind, placebo-controlled study in intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manage 31:393–406, 2006.CrossRefGoogle Scholar
Ellis, DJ, Dissanayake, S, McGuire, D, et al. Continuous intrathecal infusion of ziconotide for treatment of chronic malignant and nonmalignant pain over 12 months: a prospective, open-label study. Neuromodulation 11:40–9, 2008.CrossRefGoogle ScholarPubMed
Penn, RD, Paice, JA. Adverse effects associated with the intrathecal administration of ziconotide. Pain 85:291–6, 2000.CrossRefGoogle ScholarPubMed
Fisher, R, Hassenbusch, S, Krames, E, et al. A consensus statement regarding the present suggested titration for Prialt (ziconotide). Neuromodulation 8:153–4, 2005.CrossRefGoogle Scholar
Hood, DD, Eisenach, JC, Tong, C, et al. Cardiorespiratory and spinal cord blood flow effects of intrathecal neostigmine methylsulfate, clonidine, and their combination in sheep. Anesthesiology 82:428–35, 1995.CrossRefGoogle Scholar
Yaksh, TL, Grafe, MR, Malkmus, S, et al. Studies on the safety of chronically administered intrathecal neostigmine methylsulfate in rats and dogs. Anesthesiology 82:412–27, 1995.CrossRefGoogle Scholar
Hood, DD, Eisenach, JC, Tuttle, R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anesthesiology 82:331–43, 1995.CrossRefGoogle ScholarPubMed
Klamt, JG, Dos, RM, Barbieri, NJ, Prado, WA. Analgesic effect of subarachnoid neostigmine in two patients with cancer pain. Pain 66:389–91, 1996.CrossRefGoogle ScholarPubMed
Naguib, M, Yaksh, TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with mu and alpha 2 receptor systems. Anesthesiology 80:1338–48, 1994.CrossRefGoogle ScholarPubMed
Abram, SE, Winne, RP. Intrathecal acetyl cholinesterase inhibitors produce analgesia that is synergistic with morphine and clonidine in rats. Anesth Analg 81:501–7, 1995.Google ScholarPubMed
Hwang, JH, Hwang, KS, Choi, Y, et al. An analysis of drug interaction between morphine and neostigmine in rats with nerve-ligation injury. Anesth Analg 90:421–6, 2000.Google ScholarPubMed
Hood, DD, Mallak, KA, Eisenach, JC, Tong, C. Interaction between intrathecal neostigmine and epidural clonidine in human volunteers. Anesthesiology 85:315–25, 1996.CrossRefGoogle ScholarPubMed
Mollenholt, P, Rawal, N, Gordh, T, Olsson, Y. Intrathecal and epidural somatostatin for patients with cancer – analgesic effects and postmortem neuropathologic investigations of spinal cord and nerve roots. Anesthesiology 81:534–42, 1994.CrossRefGoogle ScholarPubMed
Yaksh, TL. Spinal somatostatin for patients with cancer – risk-benefit assessment of an analgesic [editorial]. Anesthesiology 81:531–3, 1994.CrossRefGoogle Scholar
Abram, SE. Continuous spinal anesthesia for cancer and chronic pain. Reg Anesth 18:406–13, 1993.Google ScholarPubMed
Penn, RD, Paice, JA, Kroin, JS. Octreotide: a potent new non-opiate analgesic for intrathecal infusion. Pain 49:13–19, 1992.CrossRefGoogle ScholarPubMed
Deer, TR, Penn, R, Kim, CK, et al. The use of continuous intrathecal infusion of octreotide in patients with chronic pain of noncancer origin: an evaluation of efficacy in a prospective double-blind fashion. Neuromodulation 9:284–9, 2006.CrossRefGoogle Scholar
Lavand'homme, PM, Eisenach, JC. Exogenous and endogenous adenosine enhance the spinal antiallodynic effects of morphine in a rat model of neuropathic pain. Pain 80:31–6, 1999.CrossRefGoogle Scholar
Poon, A, Sawynok, J. Antinociception by adenosine analogs and inhibitors of adenosine metabolism in an inflammatory thermal hyperalgesia model in the rat. Pain 74:235–45, 1998.CrossRefGoogle Scholar
Gomes, JA, Li, X, Pan, HL, Eisenach, JC. Intrathecal adenosine interacts with a spinal noradrenergic system to produce antinociception in nerve-injured rats. Anesthesiology 91:1072–9, 1999.CrossRefGoogle ScholarPubMed
Sawynok, J. Adenosine receptor activation and nociception. Eur J Pharmacol 347:1–11, 1998.CrossRefGoogle ScholarPubMed
Lee, YW, Yaksh, TL. Pharmacology of the spinal adenosine receptor which mediates the antiallodynic action of intrathecal adenosine agonists. J Pharmacol Exp Ther 277:1642–8, 1996.Google ScholarPubMed
Sollevi, A, Belfrage, M, Lundeberg, T, et al. Systemic adenosine infusion: a new treatment modality to alleviate neuropathic pain. Pain 61:155–8, 1995.CrossRefGoogle ScholarPubMed
Belfrage, M, Segerdahl, M, Arner, S, Sollevi, A. The safety and efficacy of intrathecal adenosine in patients with chronic neuropathic pain. Anesth Analg 89:136–42, 1999.Google ScholarPubMed
Karlsten, R, Gordh, T. An A1-selective adenosine agonist abolishes allodynia elicited by vibration and touch after intrathecal injection. Anesth Analg 80:844–7, 1995.Google ScholarPubMed
Chiari, A, Yaksh, TL, Myers, RR, et al. Preclinical toxicity screening of intrathecal adenosine in rats and dogs. Anesthesiology 91:824–32, 1999.CrossRefGoogle Scholar
Eisenach, JC, Hood, DD, Curry, R. Phase I safety assessment of intrathecal injection of an American formulation of adenosine in humans. Anesthesiology 96:24–8, 2002.CrossRefGoogle ScholarPubMed
Eisenach, JC, Hood, DD, Curry, R. Preliminary efficacy assessment of intrathecal injection of an American formulation of adenosine in humans. Anesthesiology 96:29–34, 2002.CrossRefGoogle ScholarPubMed
Ohlsson, L, Rydberg, T, Eden, T, et al. Cancer pain relief by continuous administration of epidural morphine in a hospital setting and at home. Pain 48:349–53, 1992.CrossRefGoogle Scholar
Samuelsson, H, Hedner, T. Pain characterization in cancer patients and the analgetic response to epidural morphine. Pain 46:3–8, 1991.CrossRefGoogle ScholarPubMed
Walker, SM, Goudas, LC, Cousins, MJ, Carr, DB. Combination spinal analgesic chemotherapy: a systematic review. Anesth Analg 95:674–715, 2002.Google ScholarPubMed
Scott, NB, Mogensen, T, Bigler, D, et al. Continuous thoracic extradural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response. Br J Anaesth 62:253–7, 1989.CrossRefGoogle ScholarPubMed
Solomon, RE, Gebhart, GF. Synergistic antinociceptive interactions among drugs administered to the spinal cord. Anesth Analg 78:1164–72, 1994.CrossRefGoogle ScholarPubMed
Mao, J, Price, DD, Mayer, DJ. Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interactions. Pain 62:259–74, 1995.CrossRefGoogle ScholarPubMed
Elliott, K, Minami, N, Kolesnikov, YA, et al. The NMDA receptor antagonists, LY274614 and MK-801, and the nitric oxide synthase inhibitor, NG-nitro-L-arginine, attenuate analgesic tolerance to the mu-opioid morphine but not to kappa opioids. Pain 56:69–75, 1994.CrossRefGoogle ScholarPubMed
Mayer, DJ, Mao, J, Price, DD. The development of morphine tolerance and dependence is associated with translocation of protein kinase C. Pain 61:365–74, 1995.CrossRefGoogle ScholarPubMed
Bennet, D, Burchiel, K, Buchser, E, et al. Clinical guidelines for intraspinal infusion: report of an expert panel. J Pain and Symptom Manage 20:S37–43, 2000.CrossRefGoogle Scholar
Stearns, L, Boortz-Marx, R, DuPen, S, et al. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J Support Oncol 3:399–408, 2005.Google ScholarPubMed
Du Pen, SL, Du Pen, AR, Polissar, N et al. Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 17:361–70, 1999.CrossRefGoogle ScholarPubMed
Nitescu, P, Appelgren, L, Linder, L-E, et al. Epidural versus intrathecal morphine-bupivacaine: assessment of consecutive treatments in advanced cancer pain. J Pain Symptom Manage 5:18–26, 1990.CrossRefGoogle ScholarPubMed
Hicks, F, Simpson, KH, Tosh, GC. Management of spinal infusions in palliative care. Palliat Med 8:325–32, 1994.CrossRefGoogle ScholarPubMed
Mercadante, S. Intrathecal morphine and bupivacaine in advanced cancer pain patients implanted at home. J Pain Symptom Manage 9:201–7, 1994.CrossRefGoogle ScholarPubMed
Tryba, M, Zenz, M, Strumpf, M. Long term epidural catheters in terminally ill patients – a prospective study of complications in 129 patients. Anesthesiology 73:A784, 1990.CrossRefGoogle Scholar
Plummer, JL, Cherry, DA, Cousins, MJ, et al. Long-term spinal administration of morphine in cancer and non-cancer pain: a retrospective study. Pain 44:215–20, 1991.CrossRefGoogle ScholarPubMed
Jong, PC, Kansen, PJ. A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain. Anesth Analg 78:94–100, 1994.Google ScholarPubMed
Poletti, CE, Cohen, AM, Todd, DP, et al. Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration. J Neurosurg 55:581–4, 1981.CrossRefGoogle ScholarPubMed
Gourlay, GK, Plummer, JL, Cherry, DA, et al. Comparison of intermittent bolus with continuous infusion of epidural morphine in the treatment of severe cancer pain. Pain 47:135–40, 1991.CrossRefGoogle ScholarPubMed
Shaves, M, Barnhill, D, Bosscher, J, et al. Indwelling epidural catheters for pain control in gynaecologic cancer patients. Obstet Gynecol 77:642–4, 1991.Google Scholar
Harbaugh, RE, Coombs, DW, Saunders, RL, et al. Implanted continuous epidural morphine infusion system. J Neurosurg 56:803–6, 1982.CrossRefGoogle ScholarPubMed
Coombs, DW, Fine, N. Spinal anesthesia using subcutaneously implanted pumps for intrathecal drug infusion. Anesth Analg 73:226–31, 1991.CrossRefGoogle ScholarPubMed
Smitt, PS, Tsafka, A, Teng-van de Zande, F, et al. Outcome and complications of epidural analgesia in patients with chronic cancer pain. Cancer 83:2015–22, 1998.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
De Cicco, M, Matovic, M, Castellani, GT, et al. Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization. Anesthesiology 82:765–71, 1995.CrossRefGoogle ScholarPubMed
Nitescu, P, Sjoberg, M, Appelgren, L, Curelaru, I. Complications of intrathecal opioids and bupivacaine in the treatment of ‘refractory’ cancer pain. Clin J Pain 11:45–62, 1995.CrossRefGoogle ScholarPubMed
Follett, KA, Boortz-Marx, RL, Drake, JM, et al. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology 100:1582–94, 2004.CrossRefGoogle ScholarPubMed
Byers, K, Axelrod, P, Michael, S, Rosen, S. Infections complicating tunnelled intraspinal catheter systems used to treat chronic pain. Clin Infect Dis 21:403–8, 1995.CrossRefGoogle Scholar
Van Diejen, D, Driessen, JJ, Kaanders, JH. Spinal cord compression during chronic epidural morphine administration in a cancer patient. Anaesthesia 42:1201–3, 1987.CrossRefGoogle Scholar
Cherry, DA, Plummer, JL, Gourlay, GK. Letter to the editor about epidural opiates and local anesthetics for the management of cancer pain. Pain 48:469, 1992.CrossRefGoogle Scholar
Schoeffler, P, Pichard, E, Ramboatiana, R, et al. Bacterial meningitis due to infection of a lumbar drug release system in patients with cancer pain. Pain 25:75–7, 1986.CrossRefGoogle ScholarPubMed
Coombs, DW, Fratkin, JD, Frederick, AM, et al. Neuropathologic lesions and CSF morphine concentrations during chronic continuous intraspinal morphine infusion. A clinical and post mortem study. Pain 21:337–51, 1985.CrossRefGoogle Scholar
Johnston, SP, Harland, MKW. Spinal cord compression from precipitation of drug solute around an epidural catheter. Br J Neurosurg 12:445–7, 1998.CrossRefGoogle ScholarPubMed
Yaksh, TL, Noueihed, RY, Durant, AC. Studies of the pharmacology and pathology of intrathecally administered 4-anilinipiperidine analogues and morphine in the rat and cat. Anesthesiology 64:54–66, 1986.CrossRefGoogle Scholar
Sjoberg, M, Karlsson, P-A, Nordborg, C, et al. Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 76:173–86, 1992.CrossRefGoogle ScholarPubMed
Wagemans, MF, Valk, P, Spoedler, EM, et al. Neurohistopathological findings after continuous intrathecal administration of morphine or a morphine/bupivacaine mixture in cancer pain patients. Acta Anaesthesiol Scand 41:1033–8, 1997.CrossRefGoogle ScholarPubMed
Smitt, PS, Tsafka, A, Bent, MJ, et al. Spinal epidural abscess complicating epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging. J Neurol 246:815–20, 1999.CrossRefGoogle Scholar
Schiff, D, Shaw, EG, Cascino, TL. Outcome after spinal re-irradiation for malignant epidural spinal cord compression. Ann Neurol 37:583–9, 1995.CrossRefGoogle Scholar
Appelgren, L, Nordberg, C, Sjoberg, M, et al. Spinal epidural metastasis: implications for spinal analgesia to treat ‘refractory’ cancer pain. J Pain Symptom Manage 13:25–42, 1997.CrossRefGoogle ScholarPubMed
Cherry, DA, Gourlay, GK, Cousins, MJ. Epidural mass associated with lack of efficacy of epidural morphine and undetectable CSF morphine concentrations. Pain 25:69–73, 1986.CrossRefGoogle ScholarPubMed
Erdine, S, Aldemir, T. Long-term results of peridural morphine in 225 patients. Pain 45:155–9, 1991.CrossRefGoogle ScholarPubMed
Horlocker, TT, Wedel, DJ, Benzon, H et al. Regional anesthesia in the anticoagulated patient: defining the risks. Reg Anesth Pain Med 29:1–11, 2004.Google Scholar

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