# CANCER PAIN:  INTRASPINAL MS VS CONVENTIONAL NARCOTICS

> **NIH NIH R01** · DARTMOUTH COLLEGE · 1988 · $146,587

## Abstract

Cancer pain control has been reported in both anecdote and uncontrolled
series using both bolus and continuous techniques of epidural and
intrathecal morphine delivery.  Comparative analgesic efficacy and duration
of pain control in similar cancer pain syndromes using conventional
narcotic therapy and chronic intraspinal morphine is unknown.  Suggested
but untested advantages of intraspinal morphine include effective analgesia
when oral narcotics fail, decreased total narcotic use, improved congnitive
and psychomotor function, and decreased neurodestructive procedures for
pain control.  Continuous intratecal or epidural infusion via implanted
reservoir has the potential advantages of decreased injections over
percutaneous epidural narcotic, reduced infection and respiratory
complications, potential delivery of alternate intraspinal analgesics, and
patient convenience; percutaneous epidural techniques are less expensive,
entail less surgery and offer self control and simplicity.  All techniques
are limited by apparent tachyphylaxis to morphine analgesia.  Newer
strategies, though untested, suggest tolerance may be minimized, and thus
cancer pain control reestablished, by use of alternate intrathecal or
epidural drugs.  Thus, work is needed to 1) document comparative analgesic
and functional outcomes and tolerance development in conventional therapy
versus chronic percutaneous epidural or implanted pump delivered
intrathecal morphine; 2) to develop and test new drugs and strategies to
combat spinal narcotic tolerance.

Our purpose is to:  1) continue outpatient accrual for comparison of cancer
pain control (analgesic efficacy, functional status, cognitive function) in
stratified populations with similar regional cancer pain syndromes (pain
below diaphragm group plus pain above diaphragm) with similar baseline
narcotic requirements using a) continuous intrathecal morphine or b) an
experienced oncology service using conventional narcotic regimens, and
after accrual of 20 patients in both a and b, c) to compare chronic
percutaneous epidural morphine with a and b; 2) establish pharmacokinetic
and pharmacodynamic characteristics of intrathecal morphine, hydromorphone,
and clonidine in prospective alternate intrathecal agents in cancer pain
patients; 3) document both adverse effects of intrathecal analgesics on
spinal cord function (serial somatosensory evoked potentials) and gross
histopathology of spinal cord; and lastly 4) to employ chronic intrathecal
canine and rat models to develop and test new drugs and strategies for
ameliorating spinal narcotic tolerance in order to restore pain control and
reduce need for neuroablative cancer pain procedures.

## Key facts

- **NIH application ID:** 3171635
- **Project number:** 5R01CA033865-05
- **Recipient organization:** DARTMOUTH COLLEGE
- **SAM.gov UEI:** EB8ASJBCFER9
- **Principal Investigator:** DENNIS W COOMBS
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 1988
- **Award amount:** $146,587
- **Award type:** 5
- **Project period:** 1984-01-01 → 1989-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/3171635

## Citation

> US National Institutes of Health, RePORTER application 3171635, CANCER PAIN:  INTRASPINAL MS VS CONVENTIONAL NARCOTICS (5R01CA033865-05). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/3171635. Licensed CC0.

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