INTRATHECAL AND EPIDURAL SOMATOSTATIN FOR PATIENTS WITH CANCER - ANALGESIC EFFECTS AND POSTMORTEM NEUROPATHOLOGIC INVESTIGATIONS OF SPINAL-CORD AND NERVE ROOTS

Background: The antinociceptive effects of somatostatin (SST) after in trathecal administration in rats and dogs and analgesic effects after intrathecal or epidural administration in humans were described previo usly. In this study, we seek to determine the efficacy of SST in cance r pain management and its potential neurotoxicity. Methods: Eight pati ents with intractable cancer pain were studied. Pain intensity was ass essed by patients on a four-grade scale (severe, moderate, mild, none) . Additional analgesic drug requirements before and concomitant with S ST treatment were used to evaluate the pain relief and assessed on a f our-grade scale (poor, fair, good, or excellent). Spinal cords of five patients were autopsied. Results: The mean duration of SST treatment was 11.3 days. The mean daily dose was 1,252 mu g (range 250-3,000 mu g). In six patients the pain relief was rated ''excellent'' or ''good' ' and in two patients it was assessed ''poor'' or ''fair''. None of th e patients demonstrated any evidence of neurologic deficit related to the SST treatment. At autopsy, two patients exhibited a moderate demye lination of some spinal dorsal roots and one patient also had a slight demyelination of the dorsal columns. Conclusions: SST administered in trathecally and epidurally was an effective analgesic in patients with terminal cancer. Because the described neuropathologic changes could also be cancer-related or result from chemotherapy or radiation therap y we suggest that further judicious use of SST is justified in this ca tegory of patients, if their pain remains unrelieved despite large dos es of opioid analgesics.