ALLEVIATION OF PAIN IN CANCER-PATIENTS BY ADRENAL-MEDULLARY TRANSPLANTS IN THE SPINAL SUBARACHNOID SPACE

The treatment of intractable pain with currently available therapeutic regimens is often unsatisfactory due to tolerance and untoward compli cations. Studies in our laboratory have suggested that the transplanta tion of adrenal medullary tissue into the spinal subarachnoid space ca n significantly reduce pain in animal models, most likely via release of opioid peptides and catecholamines. The current study was an initia l attempt to assess the potential for adrenal medullary transplants in the spinal subarachnoid space to alleviate pain in humans. Donor adre nal medullary tissue was prepared for transplantation in our laborator y. One cc of adrenal medullary tissue was transplanted via lumbar punc ture in five patients suffering from terminal cancer pain. Pain levels were determined using a Visual Analog Pain Scale prior to and followi ng the transplantation procedure. In addition, records of narcotic int ake and activity were kept. When possible, CSF samples were collected via lumbar puncture for biochemical and cytological analysis. Four of the patients demonstrated progressive decreases in pain scores followi ng the procedure, with concomitant reductions in narcotic intake. Thre e patients remained pain free, two for over 10 mo. One patient, who de veloped spinal cord compression secondary to metastasis, was initially pain free, but the pain returned after 10 wk. The fifth patient had n o pain reduction by 1 mo following the procedure, but further informat ion was unavailable due to poor patient compliance. In most cases, spi nal cerebrospinal fluid (CSF) samples revealed increased levels of met -enkephalin and/or catecholamines following the transplants. The resul ts of this study suggest that adrenal medullary transplants in the spi nal subarachnoid space have potential as an alternative approach to th e management of chronic pain in humans.