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Pharmacology of Medications Used in Spinal Injection Procedures

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Interventional Radiology of the Spine
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Overview

Spinal injection procedures employ many different techniques to provide pain relief for a myriad of medical conditions. Interventional pain management strategies and techniques have grown exponentially; nevertheless, many of the medications used for these procedures are quite similar.

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References

  1. Sternbach RA. Pain and “hassles” in the United States: findings of the Nuprin pain report. Pain 1986; 27: 69–80.

    Article  PubMed  CAS  Google Scholar 

  2. American Academy of Pain Medicine. Frequently asked questions about pain. Available at http://www.painmed.org/ faqs/pain_faqs.html. Accessed October 21, 2002.

    Google Scholar 

  3. Hill CS Jr. Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin. J Pain Symp Manag 1996; 11: 287–298.

    Article  Google Scholar 

  4. Joranson DE, Berger JW. Regulatory issues in pain management. J Am Pharmaceut Assoc 2000;40(5 Suppl 1):560561.

    Google Scholar 

  5. Millan M. The induction of pain: an integrative review. Prog Neurobiol 1999; 57: 1–164.

    Article  PubMed  CAS  Google Scholar 

  6. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–979.

    Article  PubMed  CAS  Google Scholar 

  7. Way EL. Review and overview of four decades of opiate research. Adv Biochem Psychopharmacol 1979; 20: 3–27.

    PubMed  CAS  Google Scholar 

  8. Sherrington CS. The Integrative Action of the Nervous System. New York: Charles Scribner, 1906.

    Google Scholar 

  9. Herz A, Teschemacher H. Activities and sites of antinociceptive action of morphine-like analgesics and kinetics of distribution following intravenous, intracerebral and intraventricular application. Adv Drug Res 1971; 6: 79119.

    Google Scholar 

  10. Pert CB, Kuhar MJ, Snyder SH. Opiate receptor autoradio-graphic localization in rat brain. Proc Natl Acad Sci USA 1976; 73: 3729–3733.

    Article  PubMed  CAS  Google Scholar 

  11. Basbaum AI. Anatomical substrates of pain and pain modulation and their relation to analgesic drug action. In: Kuhar M, Pasternak G, eds. Analgesics: Neurochemical, Behavioral and Clinical Perspectives. New York: Raven, 1984; 97–123.

    Google Scholar 

  12. Mantyh PW. Connections of midbrain periaqueductal gray in monkey-part II: descending efferent projections. J Neurophysiol 1983; 49: 582–594.

    PubMed  CAS  Google Scholar 

  13. Ruda MA, Bennett GJ, Dubner R. Neurochemistry and neurocircuitry in the dorsal horn. Prog Brain Res 1986; 66: 219–268.

    Article  PubMed  CAS  Google Scholar 

  14. Kerr FWL. Pain: a central inhibitory balance theory. Mayo Clin Proc 1975; 50: 685–690.

    PubMed  CAS  Google Scholar 

  15. LeBars D, Dickenson AH, Besson JM, et al. Aspects of sensory processing through convergent neurons. In: Yaksh TL, ed. Spinal Afferent Processing. New York: Plenum, 1986; 330–372.

    Google Scholar 

  16. Yaksh TL. Inhibition by etorphine of the discharge of dorsal horn neurons: effects upon the neuronal response to both high-and low-threshold sensory input in the decerebrate spinal cat. Exp Neurol 1978; 60: 23–40.

    Article  PubMed  CAS  Google Scholar 

  17. Mayer DJ, Price DD. Central nervous system mechanisms of analgesia. Pain 1976; 2: 379.

    Article  PubMed  CAS  Google Scholar 

  18. Glazer EJ, Steinbusch H, Verhofstad A, et al. Serotonin neurons in nucleus raphe dorsalis and paragigantocellularis of the cat contain enkephalin. J Physiol 1981; 77: 241–245.

    CAS  Google Scholar 

  19. Mudge AW, Leeman SF, Fischback GD. Enkephalin inhibits release of substance P from sensory neurons in culture and decreases action potential duration. Proc Natl Acad Sci USA 1979; 76: 526–530.

    Article  PubMed  CAS  Google Scholar 

  20. Yaksh TL, Jessell TM, Gamse R, et al. Intrathecal morphine inhibits substance P released from mammalian spinal cord in vivo. Nature 1980; 286: 155–156.

    Article  PubMed  CAS  Google Scholar 

  21. Cruz L, Basbaum AI. Multiple opioid peptides and the modulation of pain: immunohistochemical analysis of dynorphin and enkephalin in the trigeminal nucleus caudalis and spinal cord of the cat. J Comp Neurol 1985; 240: 33 1348.

    Google Scholar 

  22. Iadarola MJ, Brady LS, Draisci G, et al. Enhancement of dynorphin gene expression in spinal cord following experimental inflammation: stimulus specificity, behavioral parameters and opioid receptor binding. Pain 1988; 35: 313–326.

    Article  PubMed  CAS  Google Scholar 

  23. Dockray GJ, Sharkey KA. Neurochemistry of visceral afferent neurons. In: Cervero F, Morrison JFB, eds. Progress in Brain Research. New York: Elsevier, 1986; 67: 133–148.

    Google Scholar 

  24. Murase K, Randic M. Actions of substance P on rat spinal dorsal horn neurons. J Physiol 1984; 346: 203–217.

    PubMed  CAS  Google Scholar 

  25. Magher JW, Bennett GJ. The neurobiology of pain. Lancet 1999; 353: 1610–1615.

    Article  Google Scholar 

  26. Hammond DL. Control systems for nociceptive afferent processing: the descending inhibitory pathways. In: Yaksh TL, ed. Spinal Afferent Processing. New York: Plenum, 1986; 363–390.

    Google Scholar 

  27. Dubner R. Specialization in nociceptive pathways: sensory discrimination sensory modulation, and neural connectivity. In: Fields HL, Dubner R, Cervero F, eds. Advances in Pain Research and Therapy. New York: Raven, 1985; 9: 111–137.

    Google Scholar 

  28. Yaksh TL, Hammond DL. Peripheral and central substrates in the rostra] transmission of nociceptive information. Pain 1982; 13: 1–85.

    Article  PubMed  CAS  Google Scholar 

  29. Yaksh TL. Behavioral and autonomic correlates of the tactile evoked allodynia produced by spinal glycine inhibition: effects of modulatory receptor systems and excitatory amino acid antagonists. Pain 1989; 37: 111–123.

    Article  PubMed  CAS  Google Scholar 

  30. Dubner R. Neural circuitry mediating nociception in the medullary on spinal dorsal horn. In: Kruger L, Liebeskind JC, eds. Advances in Pain Research and Therapy. New York: Raven, 1984; 6: 151–166.

    Google Scholar 

  31. Jo YH, Schlichter R. Synaptic co-release of ATP and GABA in cultured spinal neurons. Nat Neurosci 1999; 2: 241–245.

    Article  PubMed  CAS  Google Scholar 

  32. Mather LE, Tucker GT, Murphy TM, et al. The effects of adding adrenaline to etidocaine and lignocaine in extradural anesthesia-part II: pharmacokinetics. Br J Anaesth 1976; 48: 989–994.

    Article  PubMed  CAS  Google Scholar 

  33. Waldman SD. Epidural nerve block. In: Weiner RS, ed. Innovations in Pain Management. Orlando: PMD Press, 1990; 4–5.

    Google Scholar 

  34. Waldman SD. Issues in selection of local anesthetics. Hosp Formulary 1991; 26: 590–597.

    CAS  Google Scholar 

  35. Waldman SD. Acute and postoperative pain management. In: Weiner RS, ed. Innovations in Pain Management. Orlando: PMD Press, 1993; 12–13.

    Google Scholar 

  36. Ritchie JM, Greene NM. Local anesthetics. In: Gilman AG, Goodman LS, Rall TW, Murad F, eds. The Pharmacological Basis of Therapeutics, 7th edit. New York: Macmillan, 1985; 15: 302–321.

    Google Scholar 

  37. Strichartz GR. Current concepts of the mechanism of action of local anesthetics. J Dent Res 1981; 60: 1460–1467.

    Article  PubMed  CAS  Google Scholar 

  38. Nathan PW, Sears TA. Some factors concerned in differential nerve block by local anaesthetics. J Physiol 1961; 157: 565–580.

    PubMed  CAS  Google Scholar 

  39. Tucker GT, Boyes RN, Bridenbaugh PO, et al. Binding of anilide-type local anesthetics in human plasma-part I: relationships between binding, physicochemical properties, and anesthetic activity. Anesthesiology 1970; 33: 287–303.

    Article  PubMed  CAS  Google Scholar 

  40. Solomon RE, Gebhart GF. Synergistic antinociceptive interactions among drugs administered to the spinal cord. Anesth Analg 1994; 78: 1164–1172.

    Article  PubMed  CAS  Google Scholar 

  41. Erdermir HA, Soper LE, Sweet RB. Studies of the factors affecting peridural anesthesia. Anesth Analg 1965; 44: 400.

    Google Scholar 

  42. Littlewood DG, Scott DB, Wilson J, et al. Comparative anaesthetic properties of various local anaesthetic agents in extradural block for labour. Br J Anaesth 1977; 49: 75–79.

    Article  PubMed  CAS  Google Scholar 

  43. Galindo A, Hernandez J, Benavides O, et al. Quality of spinal extradural anesthesia: the influence of spinal nerve root diameter. Br J Anaesth 1975; 47: 41–47.

    Article  PubMed  CAS  Google Scholar 

  44. Kozody R, Swartz J, Palahniuk RJ, et al. Spinal cord blood flow following subarachnoid lidocaine. Can Anaesth Soc J 1985; 32: 472–478.

    Article  PubMed  CAS  Google Scholar 

  45. Mulroy MF. Peripheral nerve blockade. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia, 2nd edit. Philadelphia: Lippincott, 1992; 31: 841–870.

    Google Scholar 

  46. Destouet JM, Gilula LA, Murphy WA, et al. Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results. Radiology 1982; 145: 321–325.

    PubMed  CAS  Google Scholar 

  47. Graf BM, Martin E, Bosniak ZJ, et al. Stereospecific effect of bupivacaine isomers on atrioventricular conduction in the isolated perfused guinea pigs heart. Anesthesiology 1997; 86: 410–419.

    Article  PubMed  CAS  Google Scholar 

  48. Armitage EN. Lumbar and thoracic epidural. In: Wildsmith JAW, Armitage EN, eds. Principles and Practice of Regional Anesthesia. New York: Churchill Livingstone, 1987; 109.

    Google Scholar 

  49. Ventafridda V, Tamburini M, Caraceni A, et al. A validation study of the WHO method for cancer pain relief. Cancer 1987; 59: 850–856.

    Article  PubMed  CAS  Google Scholar 

  50. Rumbsy MG, Finean JB. The action of organic solvents on the myelin sheath of peripheral nerve tissue-part II: short-chain aliphatic alcohols. J Neurochem 1966; 13: 1509–1511.

    Article  Google Scholar 

  51. Merrick RL. Degeneration and recovery of autonomic neurons following alcohol block. Ann Surg 1941; 113: 298.

    Article  PubMed  CAS  Google Scholar 

  52. Smith MC. Histological findings following intrathecal injection of phenol solutions for the relief of pain. Dan Med Bull 1969; 16: 116–119.

    Google Scholar 

  53. Bogduk N, Tynan W, Wilson SS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981; 132: 39–56.

    PubMed  CAS  Google Scholar 

  54. Wood KA. The use of phenol as a neurolytic agent: a review. Pain 1978; 5: 205–229.

    Article  PubMed  CAS  Google Scholar 

  55. Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 1976; 192: 1357–1358.

    Article  PubMed  CAS  Google Scholar 

  56. Jaffe JH, Martin WR. Opioid analgesics and antagonists. In: Gilman AG, Goodman LS, Rall TW, Murad F, eds. The Pharmacological Basis of Therapeutics, 7th edit. New York: Macmillan, 1985; 22: 491–531.

    Google Scholar 

  57. Martin WR. Pharmacology of opioids. Pharmacol Rev 1983; 35: 283–323.

    PubMed  CAS  Google Scholar 

  58. Chang KJ, Cuatrecasas P. Heterogeneity and properties of opiate receptors. Fed Proc 1981; 40: 2729–2734.

    PubMed  CAS  Google Scholar 

  59. Duggan AW, North RA. Electrophysiology of opioids. Pharmacol Rev 1983; 35: 219–282.

    PubMed  CAS  Google Scholar 

  60. Rawal N. Spinal opioids. In: Raj PP, ed. Practical Management of Pain, 3rd edit. St. Louis: Mosby-Year Book, 2000; 829–851.

    Google Scholar 

  61. Yaksh TL. Spinal opiate analgesia: characteristics and principles of actions. Pain 1981; 11: 347–354.

    Article  Google Scholar 

  62. Reynolds L, Kedlaya D. Spinal administration of opioids for pain of malignant origin. In: Waldman SD, ed. Interventional Pain Management, 2nd edit. Philadelphia: WB Saunders, 2001; 59: 605–608.

    Google Scholar 

  63. Crul BJ, Delhaas EM. Technical complications during longterm subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg Anesth 1991; 16: 209–213.

    PubMed  CAS  Google Scholar 

  64. Hassenbusch SJ, Paice JA, Patt RB, et al. Clinical realities and economic considerations: economics of intrathecal therapy. J Pain Symp Manag 1997; 14: S36 — S48.

    Article  CAS  Google Scholar 

  65. Haynes RC, Murad F. Adrenocorticotropic hormone:adrenocorticosteroids and their synthetic analogs: inhibitors of adrenocortical steroid biosynthesis. In: Gilman AG, Goodman LS, Rall TW, Murad F, eds. The Pharmacological Basis of Therapeutics, 7th edit. New York: Macmillan, 1985; 63: 1459–1489.

    Google Scholar 

  66. Parrillo JE, Fauci AS. Mechanisms of glucocorticoid action on immune processes. Annu Rev Pharmacol Toxicol 1979; 19: 179–201.

    Article  PubMed  CAS  Google Scholar 

  67. MacGregor RR. Granulocyte adherence changes induced by hemodialysis endotoxin, epinephrine and glucocorticoids. Ann Intern Med 1977; 86: 35–39.

    CAS  Google Scholar 

  68. Granelli-Piperano A, Vassali JD, Reich E. Secretion of plasminogen activator by human polymorphonuclear leukocytes: modulation by glucocorticoids and other effectors. J Exp Med 1977; 146: 1693–1706.

    Article  Google Scholar 

  69. Hirata F, Schiffmann F, Venkatasubamanian K, et al. A phospholipase A2 inhibitory protein in rabbit neutrophils induced by glucocorticoids. Proc Natl Acad Sci USA 1980; 77: 2533–2536.

    Article  PubMed  CAS  Google Scholar 

  70. Burn JM, Guyer PB, Langdon L. The spread of solutions injected into the epidural space: a study using epidurograms in patients with the lumbosciatic syndrome. Br J Anaesth 1973; 45: 338–345.

    Article  PubMed  CAS  Google Scholar 

  71. American College of Radiology. Manual on Contrast Media, 4th edit. Reston, VA: American College of Radiology, 1998.

    Google Scholar 

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Lippert, J.A. (2004). Pharmacology of Medications Used in Spinal Injection Procedures. In: McGraw, J.K. (eds) Interventional Radiology of the Spine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-418-4_7

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  • DOI: https://doi.org/10.1007/978-1-59259-418-4_7

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-419-7

  • Online ISBN: 978-1-59259-418-4

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