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Morphine responsiveness in a group of well‐defined multiple sclerosis patients: A study with i.v. morphine
Author(s) -
Kaiman Sigga,
Österberg Anders,
Sörensen Jan,
Boivie Jörgen,
Bertler Åke
Publication year - 2002
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1053/eujp.2001.0307
Subject(s) - morphine , multiple sclerosis , medicine , group (periodic table) , anesthesia , psychology , psychiatry , chemistry , organic chemistry
Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid‐free patients (eight woman and six men) with constant, non‐fluctuating, long‐lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non‐randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP. © 2002 European Federation of Chapters of the International Association for the Study of Pain