oxymorphone and Edema

Despite the increasing popularity of intrathecal infusions to treat patients with long-term non-cancer-related pain, this therapy is not without serious side-effects. Five out of 23 patients who had intrathecal infusions of opiates for longer than 24 months developed leg and feet edema. As predisposing factors, cardiovascular disease, deep venous thrombosis, peripheral vascular disease, and venous stasis of the lower extremities were considered. Every patient who developed pedal and leg edema after the implantation of an infusion pump was also found to have leg edema and venous stasis prior to the time when the pump was inserted. This complication was severe enough to limit their physical activity, and to produce lymphedema, ulcerations and hyperpigmentation of the skin. Reduction of the edema occurred when the dose of the opiate was decreased, and in two cases in which the infusion was discontinued, there was almost complete resolution of the syndrome. It appears that the pre-existence of pedal edema and of venous stasis is a relative contraindication to the long-term intrathecal infusion of opiates in patients with chronic non-cancer pain.

Topics: Arachnoiditis; Causality; Chronic Disease; Comorbidity; Contraindications; Edema; Foot; Hyperpigmentation; Incidence; Infusion Pumps, Implantable; Injections, Spinal; Leg; Lymphedema; Morphine; Narcotics; Oxymorphone; Pseudarthrosis; Retrospective Studies; Skin; Venous Insufficiency

The oedema produced in the mouse by intraplantar injection of the venom of Trimeresurus flavoviridis was inhibited by morphine (Mo) and by naloxone (Nx); the action of Mo increased with the dose, whereas that of Nx first progressed and thereafter regressed with the dose; very small doses of Nx antagonized Mo. Methylnaloxone (MeNx), a quaternary ammonium derivative of Nx was much less effective than Nx by the subcutaneous route but almost as effective by the intraplantar route. Peripheral opioidergic receptors are thus likely to be involved. Very high doses of Mo acted an synergistically with an optimal dose of EDTA or zymosan; complex interactions occurred between lower doses of Mo or Nx and EDTA or zymosan.

Topics: Animals; Crotalid Venoms; Dose-Response Relationship, Drug; Drug Interactions; Edema; Edetic Acid; Foot; Injections; Kinetics; Male; Mice; Morphine; Naloxone; Oxymorphone; Receptors, Opioid; Zymosan