INTRATHECAL OCTREOTIDE FOR RELIEF OF INTRACTABLE NONMALIGNANT PAIN - 5-YEAR EXPERIENCE WITH 2 CASES

SOMATOSTATIN IS DISTRIBUTED in the substantia gelatinosa in the dorsal horn of the spinal cord, and its application has been found to produc e an inhibitory effect on nociceptive neurons. Although intraspinal ad ministration of somatostatin-14 produces pain relief in patients with cancer and in postoperative patients, its short half-life limits its c linical usefulness. Octreotide, a synthetic analog of somatostatin, is more stable and has not been associated with neurodegenerative change s when administered intrathecally in dogs. Intrathecal octreotide prov ides analgesia without adverse drug effects when administered chronica lly for cancer pain; however, treatment periods have been limited. Thi s article describes the 5-year clinical course of two patients receivi ng intrathecal octreotide for severe, intractable nonmalignant pain. I ncluded in this description are the results of blinded, randomized ''N of 1'' trials conducted in each of these patients.