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American Society for Action on Pain

UI - 000139

AU - Lee TL

AU - Kumar A

AU - Baratham G

TI - Intraventricular morphine for intractable craniofacial pain

AB - This case management report on a patient with advanced craniofacial neoplasm discusses the

successful treatment of chronic pain by the cortical intraventricular narcotic administration. A previously

treated patient with surgery and radiotherapy for carcinoma of the palate developed severe intractable pain

despite high dose oral morphine therapy. Investigations revealed that neoplasm had reoccurred with

extensive infiltration. Intraventricular morphine therapy was discussed and accepted by the patient and

family. A ventricular shunt with an Ommaya reservoir was inserted under local anaesthesia. Preservative-free

morphine sulphate in increasing doses of 0.25 to 1 mg was administered, once daily, which kept the patient

in a pain-free state. The treatment was initiated in the hospital and continued at home till the demise of the

patient on the 9th week. The home care was provided by the nurses of Home Nursing Foundation and

Singapore Cancer Society under physician supervision. There were no complications which had been

reported in the literature, observed in the management of this patient

SO - Singapore Medical Journal 1990;31:273-27

UI - 000124

AU - Lipman AG

TI - Clinically relevant differences among the opioid analgesics. [Review]

AB - The mechanism of action of opioids and clinically relevant differences among the opioid analgesics are

described. Both endorphins (endogenous morphine-like substances) and exogenous opioids (opium alkaloids

and their derivatives) bind to opioid receptors in the human central nervous system to provide analgesia and

other effects. Some drugs, such as morphine, are true agonists, i.e., they bind to and activate receptors.

Some are partial agonists, binding to part of the receptor and causing effects that are similar to, but perhaps

less pronounced than, the effects produced by agonists. Others are antagonist, i.e., they bind to the receptor

but do not cause the associated effects. Some drugs, termed agonist-antagonist opioids, act as antagonists at

one type of receptor and agonists at another type of receptor. True agonists tend to have relatively straight-

line dose-response curves; in other words, their effect increases with increasing doses over a broad dosage

range. Partial agonists and agonist-antagonists tend to have ceiling effects; that is, they do not have the

broad dosage range of drugs such as morphine, methadone, hydromorphone, and other "strong" opioids.

This fact mediates against the use of partial agonists and agonist-antagonists in cancer patients who have

chronic pain that may increase as the disease progresses. Three major factors that should be considered

when a drug is selected for clinical use are (1) relative affinities for the different opioid receptor types, (2)

pharmacokinetic characteristics that influence onset and duration of action, and (3) whether the opioids are

strong or weak. For treatment of cancer pain, drugs with long durations of action are

preferable.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 11]

SO - American Journal of Hospital Pharmacy 1990;47:S7-1