| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY. (Drs. Cherny, Foley Houde, and Portenoy and J. Lapin)
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. (Dr. Thaler and H. Friedlander-Klar)
Department of Neurology, Cornell Medical Center, New York, NY. (Drs. Foley and Portenoy)
Article abstract –We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAE) score. Two experienced pain clinicians reviewed information about pain characteristics and designated each case according to the inferred pain mechanism (neuropathic, nociceptive, or mixed) and the degree of confidence in the inferred mechanism (definite versus probable/possible). They grouped the cases as follows: nociceptive pain only (n = 205), neuropathic pain only (n = 49), and mixed (n = 220). We compared pain relief achieved by patients with different mechanisms, with TOTPAR adjusted for significant covariates (duration of prior opioid administration, doses of opioid administered in the previous 48 hours, pain intensity at the start of the study, BUN:creatinine ratio, and dose of administered opioid). The adjusted mean TOTPAR score of the group with any neuropathic pain was significantly lower than that of the group with nociceptive pain only (26.1 versus 20.4, p = 0.02). The score of the group with definite nociceptive pain alone (adjusted mean TOTPAR = 28.0) was significantly higher than scores of the groups with possible/probable nociceptive pain (TOTPAR = 19.9), mixed mechanisms (TOTPAR = 20.2), definite neuropathic pain alone (TOTPAR = 20.6), and possible/probable neuropathic pain alone (TOTPAR = 22.9). In pairwise comparisons, there were no significant differences in the adjusted mean TOTPAR scores among the latter four groups. Among the patients with neuropathic pain, the dose-response relationship was significant. These data support the postulate that opioid responsiveness is a continuum with extensive overlap in the responsiveness of pains mediated by neuropathic, nociceptive, and mixed pain mechanisms.
Address correspondence and reprint requests to Dr. Russell K. Portenoy, Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.
Supported by National Cancer Institute grant Ca32897.
Received August 11, 1993. Accepted for publication in final form November 4, 1993.
This article has been cited by other articles:
|
|
 |
|
  S. Mishra, S. Bhatnagar, D. Gupta, and A. Diwedi Incidence and Management of Phantom Limb Pain According to World Health Organization Analgesic Ladder in Amputees of Malignant Origin American Journal of Hospice and Palliative Medicine, January 1, 2008; 24(6): 455 - 462. [Abstract] [PDF]
|
|
|
|
 |
|
 V. L. Tawfik, M. L. LaCroix-Fralish, N. Nutile-McMenemy, and J. A. DeLeo Transcriptional and Translational Regulation of Glial Activation by Morphine in a Rodent Model of Neuropathic Pain J. Pharmacol. Exp. Ther., June 1, 2005; 313(3): 1239 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Jacob Neuropathic Pain in Children With Cancer Journal of Pediatric Oncology Nursing, November 1, 2004; 21(6): 350 - 357. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Caraceni, E. Zecca, C. Bonezzi, E. Arcuri, R. Y. Tur, M. Maltoni, M. Visentin, G. Gorni, C. Martini, W. Tirelli, et al. Gabapentin for Neuropathic Cancer Pain: A Randomized Controlled Trial From the Gabapentin Cancer Pain Study Group J. Clin. Oncol., July 15, 2004; 22(14): 2909 - 2917. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Zochodne and M. B. Max An old acquaintance: Opioids in neuropathic pain Neurology, March 25, 2003; 60(6): 894 - 895. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Raghavendra, M. D. Rutkowski, and J. A. DeLeo The Role of Spinal Neuroimmune Activation in Morphine Tolerance/Hyperalgesia in Neuropathic and Sham-Operated Rats J. Neurosci., November 15, 2002; 22(22): 9980 - 9989. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Attal, F. Guirimand, L. Brasseur, V. Gaude, M. Chauvin, and D. Bouhassira Effects of IV morphine in central pain: A randomized placebo-controlled study Neurology, February 26, 2002; 58(4): 554 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Drug treatment of neuropathic pain DTB, December 1, 2000; 38(12): 89 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Weinbroum, V. Rudick, G. Paret, and R. Ben-Abraham The role of dextromethorphan in pain control Can J Anesth, June 1, 2000; 47(6): 585 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Portenoy Opioid Therapy for Chronic Nonmalignant Pain: Clinicians'Perspective J. Law Med. Ethics, December 1, 1996; 24(4): 296 - 309. [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
