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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Safety and Efficacy of Intrathecal Adenosine in Patients with Chronic Neuropathic Pain

Måns Belfrage, MD^*, Märta Segerdahl, MD, PhD^,, Staffan Arnér, MD, PhD, and Alf Sollevi, MD, PhD

Departments of Anaesthesia and Intensive Care, *St. Görans Hospital; Karolinska Hospital, Stockholm; and Huddinge University Hospital, Huddinge, Sweden

Address correspondence and reprint requests to Alf Sollevi, MD, PhD, Department of Anaesthesia and Intensive Care, K32, Huddinge University Hospital, S-141 86 Huddinge, Sweden. Address e-mail to alf.sollevi{at}anaesth.hs.sll.se

Adenosine and adenosine analogs decrease pain-like behavior in animal models of both acute nociceptive and neuropathic pain via adenosine receptor activation at spinal and/or supraspinal levels. This open study is the first in a series of intrathecal (IT) adenosine administration studied for the evaluation of efficacy and side effects in 14 patients. All had chronic neuropathic pain with tactile hyperalgesia and/or allodynia primarily of traumatic origin. The effects of IT adenosine (500 µg [n = 9] or 1000 µg [n = 5]) were evaluated. Approximate areas of tactile pain were mapped. Spontaneous and evoked pain (visual analog scale score 0–100) and tactile pain thresholds were assessed before and 60 min after injection. The injection caused transient pain (<60 min) in the lumbar region in five patients. There were no other side effects. Spontaneous and evoked pain was reduced (median score from 65 to 24 [P < 0.01] and from 71 to 12 [P < 0.01], respectively) in parallel with increased tactile pain thresholds in allodynic areas. Areas of tactile hyperalgesia/allodynia were reduced (median reduction 90%; P < 0.001). Twelve patients experienced pain relief (median 24 h). We conclude that IT adenosine transiently causes lumbar pain in a subgroup of patients and may reduce various aspects of chronic neuropathic pain.

Implications: This is the first series of patients with chronic neuropathic pain in which tolerability to spinal adenosine administration has been evaluated. A subset of patients reported transient low back pain as the only side effect. Spontaneous and evoked pain intensity decreased in most patients, an effect lasting for a median of 24 h.

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