Intraspinal analgesia: a new route for an old drug

Chronic pain control is a pressing world health problem. Despite the magnitude of this health issue, health care professionals receive little formal training in pain management, hence attempts to deal with chronically suffering patients may be futile. A new intervention, the infusion of low-dose spinal opiates via a totally implanted continuous flow pump, is providing a new approach to pain control and offering a desirable alternative to the need for escalating systemic narcotics and neuroablative procedures. A brief overview of the anatomy and physiology of the pain mechanism will be discussed as well as rationale for the use of continuous infusion of spinal opiates. Nursing interventions for the patient receiving intraspinal analgesia will also be discussed.     

Intraspinal drug delivery routes for treatment of chronic pain and spasticity

Subarachnoidal and epidural are the two most frequent routes for intraspinal drug delivery in treatment of chronic pain and spasticity. In addition, there are less frequently used intraventricular and subdural routes. In this review, basic concepts of intraspinal drug delivery using different intraspinal routes are discussed. The intrathecal administration of drugs is preferred today, mainly because of effective dosing in low volumes using portable infusion systems. Intrathecal catheters are longer lasting and have lower rates of complications than epidural; there are fewer side effects and development of tolerance in patients with chronic pain is reduced when the intrathecal route is used. Today, for long-term pain management in patients with benign chronic pain and in those cancer patients with longer life expectancy, the intrathecal route is preferred.     

运动疗法治疗椎管内硬膜下出血疼痛患者1例

患者女48岁，无明原因脊髓出血致双下肢不完全性的瘫痪，出现颈、肩、腰疼痛，二便不同程度功能障碍。MRI显示胸段经椎管内硬膜下出血，DSA未发现异常。神经外科讨论无手术指征，以保守治疗及康复训练治疗。患者疼痛评定分别采用45区体表面积图和简化MeGill疼痛问卷，运动和感觉采用美国脊柱损伤协会（ASIS）于2000年修订的第5版中运动与感觉检查项目与评分的方法，结果3者改善均明显。     

Antiviral drug therapy

Major advances in molecular virology have led to the development of new antiviral compounds. These drugs include ribavirin, used in the treatment of severe respiratory syncytial virus infection in children; amantadine, used in the prophylaxis and treatment of influenza A infection; acyclovir, used in a variety of herpesvirus infections, including primary gingivostomatitis, genital herpes and herpes zoster; ganciclovir, used in the treatment of retinitis due to cytomegalovirus, and zidovudine, used in the prophylaxis and treatment of human immunodeficiency virus infection.     

Tailor-made drug therapy

Progress in the field of pharmacogenetics has revealed that the phenotypically different responses of patients to drugs are genetically determined by the polymorphisms in the genes involved in their pharmacokinetics and pharmacodynamics. Information on genetic polymorphisms, including single nucleotide polymorphisms, found in the genes encoding drug-metabolizing enzymes, drug transporters, drug receptors, and so on, are now applicable to tailor-made(individualized) drug therapy. This report presents the current status of pharmacogenetic approaches to the individualized therapy.     

Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines

The multidimensional nature of chronic nonmalignant pain lends itself to numerous treatment options, which vary in cost and invasiveness. Based on the principle that use invasive and less costly interventions for pain treatment should be attempted first, a continuum of interventions for chronic pain states is presented. Although intraspinal opioid therapy is a relatively invasive and costly modality for pain treatment, it has a rational place in the treatment continuum for some chronic nonmalignant pain patients. A through review of the literature, supplemented by clinical experience, provides a foundation for the development of management guidelines.     

椎管内脊膜瘤的MRI分析

目的:提高对椎管内脊膜瘤MR/表现的认识.材料与方法:回顾性分析20例经手术病理证实为脊膜瘤的MRI表现及临床资料.结果:全部20例脊膜瘤均为椎管内单一发病,其中胸段15例,颈段4例,腰段1例,肿瘤T1WI呈等信号,%WI呈等或稍高信号,增强后大多为中度较均匀强化,13例可见"硬脊膜尾征".结论:脊膜瘤的MR/表现较具有特征性,MRI是诊断椎管内脊膜瘤的最佳影像检查方法.     

Intraspinal use of morphine

OBJECTIVE: To compare the different sterility standards and the cost issues involved when choosing an opioid product for intraspinal administration. DATA SOURCES: Literature accessed through MEDLINE and other Internet search engines (September 2002-April 2003) was evaluated. Key search terms included epidural/intrathecal, opioids, sterility, and compounding. DATA SYNTHESIS: Intraspinal use is prevalent in the area of pain management. Product selection is of utmost importance when administering through the intraspinal route. An evaluation of guidelines on sterility and a cost comparison were conducted. CONCLUSIONS: The preservative-free commercially available products that are indicated for intrathecal/epidural use are the best alternative due to proper outside testing and stringent quality assurance. The generic morphine preservative-free product may also be considered if proper steps are taken to ensure that the final product is diluted properly.     

Cancer drug therapy.

The chemotherapeutic treatment of cancer has evolved into a major treatment modality. Better results than ever before are being recorded with the integration of this approach into the early and total management of cancer. Although complex and toxic, these drugs and their combinations are contributing in new ways to the treatment of more and more patients. More than 50% of those people afflicted with cancer in 1991 became long-term survivors. Most of these survivors are destined to be followed on a long-term basis by their family doctor.