PMID- 32350753
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210110
IS  - 2193-8237 (Print)
IS  - 2193-651X (Electronic)
VI  - 9
IP  - 2
DP  - 2020 Dec
TI  - Triple Intrathecal Combination Therapy for End-Stage Cancer-Related Refractory 
      Pain: A Prospective Observational Study with Two-Month Follow-Up.
PG  - 783-792
LID - 10.1007/s40122-020-00169-1 [doi]
AB  - INTRODUCTION: In cancer-related pain refractory to systemic opioids, intrathecal 
      (IT) administration of morphine can be a useful strategy. In clinical practice, 
      IT morphine is usually combined with other drugs with different mechanisms of 
      action, in order to obtain a synergistic analgesic effect. However, the 
      discussion on efficacy and safety of IT combination therapy is still ongoing. The 
      aim of this observational study was to report the effects of an IT combination of 
      low doses of ziconotide, morphine, and levobupivacaine in end-stage cancer 
      refractory pain. METHODS: Sixty adult patients, 21 females and 39 males, were 
      enrolled to an IT device implant. The mean visual analogue scale of pain 
      intensity (VASPI) score was 88 +/- 20 mm. All patients started with a triple 
      combination therapy: the initial IT dose of morphine was calculated for each 
      patient based on the equivalent daily dose of morphine; an oral/IT ratio of 400/1 
      was used. For ziconotide, a standard slow titration schedule was started at 
      1.2 mug/day and the initial dose of levobupivacaine was 3 mg/day. RESULTS: The 
      initial IT mean doses of morphine, ziconotide, and levobupivacaine were 
      0.8 +/- 0.3 mg/day, 1.2 mcg/day and 3 mg/day, respectively. At day 2, a significant 
      reduction in VASPI score was registered (49 +/- 17, p < 0.001), and this 
      significant reduction persisted at 56 days (mean VASPI score 44 +/- 9, p < 0.001), 
      with mean doses of morphine 2 +/- 1 mg/day, ziconotide 2.8 +/- 1 mcg/day, and 
      levobupivacaine 3.8 +/- 2 mg/day. Very few adverse effects (AEs) were observed. 
      Patients' satisfaction was very high during the entire study period. CONCLUSIONS: 
      Our results, within the limit of the study design, suggest that the IT 
      combination of ziconotide, morphine, and levobupivacaine, at low doses, allows 
      safe and rapid control of refractory cancer pain, with high levels of patient 
      satisfaction.
FAU - Puntillo, Filomena
AU  - Puntillo F
AD  - Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, 
      Italy. filomena.puntillo@uniba.it.
FAU - Giglio, Mariateresa
AU  - Giglio M
AD  - Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy.
FAU - Preziosa, Angela
AU  - Preziosa A
AD  - Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy.
FAU - Dalfino, Lidia
AU  - Dalfino L
AD  - Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy.
FAU - Bruno, Francesco
AU  - Bruno F
AD  - Department of Emergency and Organ Transplantation, University of Bari "Aldo 
      Moro", Bari, Italy.
FAU - Brienza, Nicola
AU  - Brienza N
AD  - Department of Emergency and Organ Transplantation, University of Bari "Aldo 
      Moro", Bari, Italy.
FAU - Varrassi, Giustino
AU  - Varrassi G
AD  - Paolo Procacci Foundation, Rome, Italy.
LA  - eng
PT  - Journal Article
DEP - 20200429
PL  - New Zealand
TA  - Pain Ther
JT  - Pain and therapy
JID - 101634491
PMC - PMC7648800
OTO - NOTNLM
OT  - Cancer pain
OT  - Drug therapy combination
OT  - Intrathecal
OT  - Levobupivacaine
OT  - Morphine
OT  - Patient satisfaction
OT  - Visual analogue pain scale
OT  - Ziconotide
EDAT- 2020/05/01 06:00
MHDA- 2020/05/01 06:01
PMCR- 2020/04/29
CRDT- 2020/05/01 06:00
PHST- 2020/03/10 00:00 [received]
PHST- 2020/05/01 06:00 [pubmed]
PHST- 2020/05/01 06:01 [medline]
PHST- 2020/05/01 06:00 [entrez]
PHST- 2020/04/29 00:00 [pmc-release]
AID - 10.1007/s40122-020-00169-1 [pii]
AID - 169 [pii]
AID - 10.1007/s40122-020-00169-1 [doi]
PST - ppublish
SO  - Pain Ther. 2020 Dec;9(2):783-792. doi: 10.1007/s40122-020-00169-1. Epub 2020 Apr 
      29.