1
|
Li Q, Long YL, He YW, Long H, Xiao ZP, Li YL, Yang WZ, Jiang LP, Gao W, Zou C. Intrathecal morphine delivery at prepontine cistern to control refractory cancer-related pain: a case report of extensive metastatic and refractory cancer pain. BMC Anesthesiol 2024; 24:77. [PMID: 38408913 PMCID: PMC10895834 DOI: 10.1186/s12871-024-02426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Extensive metastatic and refractory cancer pain is common, and exhibits a dissatisfactory response to the conventional intrathecal infusion of opioid analgesics. CASE PRESENTATION The present study reports a case of an extensive metastatic esophageal cancer patient with severe intractable pain, who underwent translumbar subarachnoid puncture with intrathecal catheterization to the prepontine cistern. After continuous infusion of low-dose morphine, the pain was well-controlled with a decrease in the numeric rating scale (NRS) of pain score from 9 to 0, and the few adverse reactions to the treatment disappeared at a low dose of morphine. CONCLUSIONS The patient achieved a good quality of life during the one-month follow-up period.
Collapse
Affiliation(s)
- Qing Li
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Yan-Ling Long
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Yun-Wu He
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Hui Long
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Zhen-Ping Xiao
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Yong-Lin Li
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Wu-Zhou Yang
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Li-Ping Jiang
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Wei Gao
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China
| | - Cong Zou
- Department of Pain and Rehabilitation, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, China.
| |
Collapse
|
2
|
Edinoff AN, Patel AS, Baker MW, Lawson J, Wolcott C, Cornett EM, Sadegi K, Kaye AM, Kaye AD. Conolidine: A Novel Plant Extract for Chronic Pain. Anesth Pain Med 2021; 11:e121438. [PMID: 35291410 PMCID: PMC8908788 DOI: 10.5812/aapm.121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
: Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3’s inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.
Collapse
Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
- Corresponding Author: Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA.
| | - Akash S. Patel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Mitchell W. Baker
- Department of Orthopedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jesse Lawson
- Department of Emergency Medicine, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Christopher Wolcott
- Department of Emergency Medicine, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Kambiz Sadegi
- Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran
- Corresponding Author: Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran.
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, USA
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| |
Collapse
|
3
|
Sarrafpour S, Hasoon J, Urits I, Viswanath O, Mahmoudi K, Simopoulos TT, Gill J, Kohan L. Antibiotics for Spinal Cord Stimulation Trials and Implants: A Survey Analysis of Practice Patterns. Anesth Pain Med 2021; 11:e120611. [PMID: 35075422 PMCID: PMC8782197 DOI: 10.5812/aapm.120611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Spinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. Published guidelines exist to aid physicians in proper antibiotic use during and after spinal cord stimulation trials and implants. In this brief review, we present and analyze the current antibiotic practice patterns of clinicians. Methods The study protocol was reviewed and granted an exemption by an Institutional Review Board. The survey queried practice parameters in regards to spinal cord stimulation therapy. The American Society of Regional Anesthesia and Pain Medicine (ASRA) and Society of Interventional Spine (SIS) distributed the survey to their active members by emails with a web link to the survey. Results Our results indicate that 82% and 69% of physicians do not utilize nasal swabs for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA), respectively, prior to SCS trial and implantation. During trials, 47% providers administer a single dose of antibiotics, 35% administer antibiotics for the duration of the trial, and 17% do not administer antibiotics. During implantation, 44% of physicians administer a single dose during the procedure, 11% administer antibiotics up to 24 hours, 24% administer antibiotics between 3-5 days, 14% administer antibiotics for more than 5 days, and 4% do not administer antibiotics. Conclusions Our study suggests a portion of pain physicians do not adhere to the Neuromodulation Appropriateness Consensus Committee (NACC) guidelines in regards to antibiotic administration for SCS trial and implantation. Further analysis and surveys would allow insight into common practices. More information and education would be beneficial to optimize peri-procedure antibiotic use to reduce infection risk and decrease antimicrobial resistance.
Collapse
Affiliation(s)
- Syena Sarrafpour
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
- Corresponding Author: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
- Louisiana State University Health Sciences Center, Department of Anesthesia and Pain Management, Shreveport, LA, USA
| | - Omar Viswanath
- Louisiana State University Health Sciences Center, Department of Anesthesia and Pain Management, Shreveport, LA, USA
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
- University of Arizona College of Medicine–Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Kamran Mahmoudi
- Pain Research Center, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Thomas T. Simopoulos
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Lynn Kohan
- University of Virginia Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Charlottesville, VA, USA
| |
Collapse
|
4
|
Edinoff AN, Kaplan LA, Khan S, Petersen M, Sauce E, Causey CD, Cornett EM, Imani F, Moradi Moghadam O, Kaye AM, Kaye AD. Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations. Anesth Pain Med 2021; 11:e119156. [PMID: 34692448 PMCID: PMC8520671 DOI: 10.5812/aapm.119156] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022] Open
Abstract
Opioids are mu receptor agonists and have been an important part of pain treatment for thousands of years. In order to use these drugs appropriately and successfully in patients, whether to control pain, to treat opiate-induced side effects, or opiate withdrawal syndromes, a solid understanding of the pharmacology of such drugs is crucial. The most recognized full agonist opioids are heroin, morphine, codeine, oxycodone, meperidine, and fentanyl. Phenanthrenes refer to a naturally occurring plant-based compound that includes three or more fused rings. The opioids derived from the opium plant are phenanthrene derivatives, whereas most synthetic opioids are simpler molecules that do not have multiple rings. Methadone acts as a synthetic opioid analgesic similar to morphine in both quality and quantity; however, methadone lasts longer and in oral form, has higher efficacy, and is considered a diphenylheptane. Fentanyl is a strong synthetic phenylpiperdine derivative that exhibits activity as a mu-selective opioid agonist approximately 50 to 100 times more potent than morphine. Meperidine is another medication which is a phenylpiperdine. Tramadol is considered a mixed-mechanism opioid drug, as it is a centrally acting analgesic that exerts its effects via binding mu receptors and blocking the reuptake of monoamines. Some of the most common adverse effects shared among all opioids are nausea, vomiting, pruritus, addiction, respiratory depression, constipation, sphincter of Oddi spasm, and miosis (except in the case of meperidine). Chronic opioid usage has also established a relationship to opioid-induced hypogonadism and adrenal suppression. Physicians must be stewards of opioid use and use opioids only when necessary.
Collapse
Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Leah A. Kaplan
- Louisiana State University Shreveport, School of Medicine, Shreveport, LA, USA
| | - Sami Khan
- American University of the Caribbean, School of Medicine, USA
| | - Murray Petersen
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Emily Sauce
- Louisiana State University New Orleans, School of Medicine, New Orleans, LA, USA
| | | | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Moradi Moghadam
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| |
Collapse
|