title: A history of intraspinal analgesia, a small and personal journey.
abstract: BACKGROUND
  There is a large and robust literature on the spinal use of opioids and non-opioids alike, but unless one is my age and older, very few persons know how we got here. This small history offering tells us how we got to where we are today regarding the science, clinical uses, and management of intraspinal analgesia.
  
  
  METHODS
  I have reviewed the literature bases of Google Scholar and the National Library of Medicine using the key words: history, opium, spinal analgesia, spinal morphine, intrathecal (IT), opioid receptors, endogenous opioids, IT delivery of opioids, and IT side-effects/complications.
  
  
  RESULTS
  In this personal review of the history of intraspinal analgesia, I relate my own early and later experiences of the science and clinical uses of intraspinal morphine, other opioids, and non-opioids alike to a historical context. This review outlines a rather small history of opium, the historical use of opium and its various compounds, and the search for and answer to the question, "why was the poppy created for wondrous medicinal uses for mankind?" This search led to the discovery of endogenous opioid like chemicals, the discovery of opiate receptors for these endogenous opioids, the first uses of intraspinal opioids in animal models and man, and, finally, our understanding of the appropriate and inappropriate clinical uses of intraspinal analgesia. Within this paper, I acknowledge the works of my colleagues and the "heroes" who have laid the foundation for our understanding of intraspinal analgesia.
  
  
  CONCLUSIONS
  The history of the use of intraspinal analgesia is rich and guides us to advance the science and clinical use of intraspinal analgesia without reinventing the wheel.
authors.affiliation: Pacific Pain Treatment Center, San Francisco, CA, USA.
authors.forename: Elliot S
authors.initials: ES
authors.lastname: Krames
mesh_terms: D000698:Analgesia / Q000266:history* / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000775:Anesthesia, Spinal / Q000266:history* / Q000379:methods*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans
chemical_list: D000700:Analgesics