title: Intraspinal opiates for treatment of intractable pain in the terminally ill cancer patient.
abstract: The discovery of opiate receptors and then their endogenous ligands in 1974 (Snyder et al., 1974) has elucidated a vast pharmacology of opiates providing a basis for their diverse clinical applications. With the awareness of quality of life as a primary goal in terminal cancer patients, widespread attention has been drawn to the direct delivery of long-term intraspinal analgesics to cancer patients for who all medical pain control regimens have failed (Coombs & Saunders, 1974). Intraspinal administration of opiates and nonopiate analgesics is not only appealing on theoretical grounds but provides a minimally invasive method to insure otherwise unobtainable pain relief while eliminating obtundation and systemic side-effects associated with conventional therapy (Cobb et al., 1984; Harbaugh et al., 1982; Leavens et al., 1982; Malone et al., 1985; Onofrie et al., 1981; Poletti et al., 1981). Although intraspinal opiates have been used in the treatment of postoperative and benign-pain syndromes (Asari et al., 1981; Cousins & Mather, 1984), in our discussion we review the basic science, current techniques and possible future improvements in spinal analgesia in the control of chronic cancer pain.
authors.affiliation: Neurosurgery Section, Tucson VA Medical Center, AZ.
authors.forename: R P
authors.initials: RP
authors.lastname: Iacono
authors.forename: J
authors.initials: J
authors.lastname: Linford
authors.forename: R
authors.initials: R
authors.lastname: Sandyk
authors.forename: P
authors.initials: P
authors.lastname: Consroe
authors.forename: M R
authors.initials: MR
authors.lastname: Ryan
authors.forename: C R
authors.initials: CR
authors.lastname: Bamford
mesh_terms: D006801:Humans; D007278:Injections, Spinal; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D009369:Neoplasms / Q000628:therapy; D010148:Intractable Pain / Q000188:drug therapy* / Q000378:metabolism; D011957:Receptors, Opioid / Q000378:metabolism
chemical_list: D009294:Narcotics; D011957:Receptors, Opioid