Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine. |
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| Authors: | Sigga Kaiman,Anders
sterberg,Jan S rensen,J rgen Boivie, ke Bertler |
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| Affiliation: | 1. Department of Anaesthesiology, University Hospital, Linköping, Sweden;2. Department of Neurology, University Hospital, Linköping, Sweden;3. Department of Clinical Pharmacology, University Hospital, Linköping, Sweden;1. Health Sciences University, Bozyaka Training and Research Hospital, Department of Urology;2. Amasya University, Faculty of Medicine, Department of Urology;1. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea;2. Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea;3. Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea;4. Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Seoul, Republic of Korea;1. Process Systems Engineering Centre (PROSPECT), Universiti Teknologi Malaysia, 81310 Johor Bahru, Malaysia;2. Chemical Engineering Department, Federal University of Technology Minna, P.M.B 65 Minna, Nigeria;1. Vinh University, 182 Le Duan street, Vinh City, Viet Nam;2. Ho Chi Minh City University of Food Industry, Viet Nam;3. Ha Tinh University, Viet Nam |
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| Abstract: | Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP. |
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| Keywords: | multiple sclerosis pain morphine M6G M3G morphine responsiveness placebo response non‐responder |
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