Intrathecal administration of opioids is now considered commonplace. In 1979, when this journal’s third most cited article
was published (as of the date of this blog post), intrathecal opioids had only been used in animals. Because this usage in humans was considered experimental, the 8 subjects who initially received the drug had intractable pain due to inoperable genitourinary tract cancer with invasion into the lumbosacral plexus. Patients received either intrathecal placebo or morphine 0.5-1.0 g. In two patients, pain relief after intrathecal morphine lasted 15 hours versus 7 hours after placebo. In 6 other patients, pain relief after intrathecal morphine lasted on average 10 hours and there was no relief at all after intrathecal injection of placebo.
Little did the authors know what the implications of their work would be. As they stated in their article, “...we were sufficiently impressed by the results to submit the data for publication in the hope that others will be stimulated to evaluate independently this potential mode of symptomatic therapy for incurable cancer problems.” Additionally, in the same piece they later noted, “It is tempting to speculate that this technique may be used for obstetric analgesia or postoperative pain.”
In all fairness, it was probably August Bier who gave the first spinal anesthetic as early as 1898 when he injected between 5 and 15 mg of cocaine, resulting in a spinal block. Cocaine, however, is a local anesthetic and vasoconstrictor.
A note about terminology is warranted here. Though the term “narcotic” is used throughout the manuscript, and continues to be widely used in the same manner now as it was then, this is actually incorrect. “Narcotic” is derived from the Greek for “stupor” and was used by Hippocrates to describe the process of numbing or being in a benumbed state; it is therefore nonspecific. Certainly opium, morphine, and similar substances do cause sleepiness, but technically the terminology for such substances is “opioid” because of their mechanism of action.
are always welcome.
1. Wang JK, Nauss LA, Thomas JE: Pain relief by intrathecally applied morphine in man. Anesthesiology 1979; 50: 149-51
2. Bier A: Versuche über Cocainisirung des Ruckenmarkes. Dtsch Z Chir 1899; 51:361-369
Posted by J. Lance Lichtor, M.D.