Spinal versus Intraventricular Chronic Opiate Administration with Implantable Drug Delivery Devices for Cancer Pain
Early publications have separately reported the efficacy, specificity and conservative character of direct spinal and intraventricular morphine analgesia in the treatment of intractable cancer pain. The objectives of this study are to compare efficacy and safety of these sites of local administration in order to determine the indication for each, the clinical effects of different opiates and the choice of various drug administration devices.
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ABSTRACT: Certains patients sélectionnés victimes de douleurs chroniques du membre supérieur, peuvent bénéficier d'une approche thérapeutique neurochirurgicale. Les différentes techniques et leurs supports anatomo-physiologiques sont rappelées (techniques ablatives au niveau périphérique, de la DREZ et au niveau central — Neurostimulation périphérique, médullaire et thalamique — Infusion chronique de substance morphinique). Leurs indications sont revues à la lumière des mécanismes physiopathologiques évoqués lors des douleurs post-traumatiques, des douleurs d'origine cancéreuse, des douleurs neurogéniques et des douleurs des rhumatismes neurotrophiques. Some selectionned patients with chronic pain in the upper limb can be improved by a neurosurgical treatment. The rationale of the different surgical procedures are given (peripheral, DREZ and central ablative procedures-peripheral, spinal cord and thalamic stimulation — chronic infusion of opiates). Their indications are reviewed, in the light of the physiopathological mecanisms involved in post-traumatic pain, cancer pain, neurogenic pain, and neurotrophic rhumatisms pain.Douleur et Analgésie 09/1990; 3(3):89-97. DOI:10.1007/BF03009498 · 0.09 Impact Factor
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ABSTRACT: Two neurosurgical centers, Bologna (Italy) and Freiburg (FRG), have compared results obtained with stereotactic mesencephalotomy (SM; Bologna) and multiple thalamotomies (MT; Freiburg) in the surgical treatment of chronic cancer pain syndromes. In total, 161 patients were operated, 109 in Bologna and 52 in Freiburg. In SM the lesions were single and centered on the spinothalamic tract at the mesencephalic level, while in MT the lesions were multiple in the thalamic nuclei (ventrocaudal parvocellular nucleus, nucleus limitans, lamella medialis, centromedian nuclei). The following results emerged after 2-7 months' follow-up: (1) in an antalgic sense, SM was much more beneficial, with 91 patients (83.5%) pain-free after the operation versus 27 patients (51.9%) who had only an attenuation of the pain syndrome after MT; (2) SM, compared to MT, is burdened by mortality and a higher morbidity [2 deaths (1.8%) vs. 0; 3 anesthesia dolorosa and 8 severe gaze palsies (10.1%) vs. only 1 case of permanent aphasia (1.9%)].Applied neurophysiology 02/1987; 50(1-6):314-8. DOI:10.1159/000100733
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