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- Scope of the Problem
-
1. Cancer pain
- Prof. Judith Paice
- Current Therapies
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3. Spinal analgesia for cancer pain
- Prof. Jon Raphael
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4. Celiac plexus block
- Prof. David Brown
- Future Directions
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6. Symptom control: using technology pragmatically
- Dr. Steven Richeimer
- From Palliative Care to Chronic Pain
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7. Insight and responsibility: ethics in pain medicine and palliative care
- Prof. Rollin Gallagher
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8. The patient with pain: a palliative care approach
- Dr. Janet Abrahm
- Archived Lectures *These may not cover the latest advances in the field
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9. Cancer pain and related symptoms: an overview
- Prof. Judith Paice
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10. Cancer pain control: an evidence-based approach
- Prof. Daniel Carr
- Dr. Baraa Tayeb
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11. Optimal treatment of chronic pain
- Prof. Gordon Irving
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12. Chronic cancer pain: the price of success?
- Prof. Allen Burton
Printable Handouts
Navigable Slide Index
- Introduction
- Pain management continuum
- Opioids inhibit synaptic transmission
- Differences between normal and brain capillary
- Bypass the blood-brain barrier
- CNS distribution of systemic and spinal analgesics
- Drug distribution - spinal vs. systemic delivery
- Selective spinal analgesia
- Physiological rationale for intrathecal drug delivery
- Epidural vs. intrathecal
- Pharmacology of spinal analgesics
- Opioids - Morphine
- Other opioids
- The Smith study of intrathecal drug delivery (1)
- The Smith study of intrathecal drug delivery (2)
- The Smith study - results (1)
- The Smith study - results (2)
- The Smith study - results (3)
- Local anaesthetics
- Alpha2 adrenergic agonists
- Ziconotide (Prialt)
- Ziconotide - dosage
- Ziconotide - side effects
- Ziconotide - serious side effects
- Intrathecal ziconotide - a clinical trial
- Drug delivery - expert panel
- Intrathecal therapies: 2007 polyanalgesic algorithm
- Procedures: background
- Spinal catheter (1)
- Spinal catheter (2)
Topics Covered
- Pain management continuum
- The blood-brain barrier
- CNS distribution of spinal and systemic analgesics
- Selective spinal analgesia
- Physiological rationale
- Epidural vs. intrathecal
- Pharmacology
- Opioids
- Local anesthetics
- a2 adrenergic agonists
- Ziconotide
- Procedures
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Raphael, J. (2019, December 4). Spinal analgesia for cancer pain [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 7, 2024, from https://doi.org/10.69645/HAXR8863.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Jon Raphael has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Spinal analgesia for cancer pain
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Jon Raphael,
I'm a specialist in pain medicine and
I'm going to be talking about
spinal analgesia for cancer pain.
0:10
The place of spinal analgesia in cancer
pain management is following the more
conservative measures as outlined in
the World Health Organization's well
known ladder, thus following strong
opioids together with adjuvants if pain
relief cannot be controlled,
then advanced strategies come into play.
Of course the majority of patients' pain
can be controlled by the more conservative
measures, but
nonetheless there's a significant number
who require more advanced strategies.
Spinal analgesia is generally preferred
above the destructive procedures,
either neurologic or neurosurgical.
0:49
The story of spinal analgesia
in management of pain and
cancer pain goes back some years now
to seminal work in the mid seventies,
in which it was demonstrated
that opioids would inhibit,
nociceptive transmission level of
the dorsal horn of the spinal chord.
1:08
The rationale for delivering drugs
to this area is based on a number of
physiological principles
which will be outlined.
It mainly relies upon a fortuitous
difference in the capillaries of
the central nervous system, compared with
almost all other tissues of the body.
To look to the left of this slide,
we see that drugs can pass from
the capillaries into the tissues,
either across the membranes of the
endothelial cells, but also their passage
is aided by the ability to go through
clefts between cells and fenestrations.
However, in the central nervous
system as shown on the right,
there are no such intercellular clefts or
fenestrations, and therefore the passage
of drugs into central nervous system
tissue from the capillaries is impeded.
This is, of course, a technological
effect that protects us from toxins.
But it can be used as we will demonstrate
to the benefit of analgesia in patients
by spinal drug delivery.