Alleviation of Chronic Cancer Pain by Adrenal Medullary Transplants in the Spinal Subarachnoid Space

Work in our laboratory over the past several years has demonstrated that the transplantation of adrenal medullary chromaffin cells into the spinal subarachnoid space can markedly reduce pain in several rodent models without the development of tolerance. Adrenal medullary chromaffin cells were selected since they produce high levels of both opioid peptides and catecholamines, agents which independently, and possibly synergistically, reduce pain when injected locally into the spinal subarachnoid space. The present study was an initial attempt to assess the potential for this approach to alleviate chronic pain in man. Approval for this preliminary study was obtained from the Institutional Review Board of the University of Illinois. Consenting patients selected for the study were suffering from pain associated with terminal cancer with reduced pain control by escalating doses of narcotic analgesics. Human adrenal glands were obtained from the Regional Organ Bank of Illinois, and adrenal medullary tissue was prepared for transplantation in our laboratory. Using sterile techniques with the patient in the lateral decubi-tus position, lumbar puncture using a 14-gauge Tuohy needle was performed. After aspiration of sufficient CSF for culture, cytology, and biochemical assays, approximately 1 ml of suspended adrenal medullary tissue was injected and the needle withdrawn. Cyclosporine A (10 mg/kg orally) was administered for two weeks beginning one day prior to the procedure. Pain levels were determined using a Visual Analog pain scale prior to and at weekly intervals following the procedure. In addition, records of daily analgesics consumed were kept by the patient or patient's family. When possible, CSF samples were collected via lumbar puncture at several intervals following the implantation for cytological and biochemical analysis. Patient i was a 61 year old female with a six year history of carcinoma of the colon. As her disease advanced, she developed increasing back and lower extremity pain which became intractable , despite escalating doses of narcotics. Following transplantation, progressive decreases in pain scores and narcotic intake were reported, and the patient remained pain free until her death 41/2 months following the procedure. Her CSF met-enkephalin levels were elevated 6-fold 1 month following the procedure. Patient 2 was a 69 year old white male with a four-year history of carcinoma of the colon. His pain became progressively worse and more resistant to analgesic medications. The pain was highly position dependent, in that it became unbearable within a short period of time when he attempted to sit up. An …