Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1982 Sep;58(683):531–535. doi: 10.1136/pgmj.58.683.531

Spinal opiate analgesia and facial pruritus: a neural theory

Peter V Scott, H B J Fischer
PMCID: PMC2426462  PMID: 6755416

Abstract

Facial pruritus associated with spinal opiate analgesia in man is thought to result either from release of histamine or from imbalance of sensory modulation secondary to spread of opiate to the medulla or fourth ventricle. There is another possibility: the sensory imbalance may be secondary to rostral spread of opiate effect by nervous transmission. Evidence is adduced in support of possible anatomical pathways, and in support of a medullary ‘itching centre’ in man.

Full text

PDF
531

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adreev V. C., Petkov I. Skin manifestations associated with tumours of the brain. Br J Dermatol. 1975 Jun;92(6):675–678. doi: 10.1111/j.1365-2133.1975.tb03148.x. [DOI] [PubMed] [Google Scholar]
  2. Ahmad S., Hawes D., Dooley S., Faure E., Brunner E. A. Intrathecal morphine in a parturient with a single ventricle. Anesthesiology. 1981 Jun;54(6):515–517. doi: 10.1097/00000542-198106000-00012. [DOI] [PubMed] [Google Scholar]
  3. Atweh S. F., Kuhar M. J. Autoradiographic localization of opiate receptors in rat brain. I. Spinal cord and lower medulla. Brain Res. 1977 Mar 18;124(1):53–67. doi: 10.1016/0006-8993(77)90863-0. [DOI] [PubMed] [Google Scholar]
  4. BOWSHER D. The topographical projection of fibres from the anterolateral quadrant of the spinal cord to the subdiencephalic brain stem in man. Psychiatr Neurol (Basel) 1962;143:75–99. doi: 10.1159/000131119. [DOI] [PubMed] [Google Scholar]
  5. Baraka A., Noueihid R., Hajj S. Intrathecal injection of morphine for obstetric analgesia. Anesthesiology. 1981 Feb;54(2):136–140. doi: 10.1097/00000542-198102000-00007. [DOI] [PubMed] [Google Scholar]
  6. Barron D. W., Strong J. E. Postoperative analgesia in major orthopaedic surgery. Epidural and intrathecal opiates. Anaesthesia. 1981 Oct;36(10):937–941. doi: 10.1111/j.1365-2044.1981.tb08651.x. [DOI] [PubMed] [Google Scholar]
  7. Bernstein J. E., Grinzi R. A. Butorphanol-induced pruritus antagonized by naloxone. J Am Acad Dermatol. 1981 Aug;5(2):227–228. doi: 10.1016/s0190-9622(81)80079-5. [DOI] [PubMed] [Google Scholar]
  8. Bernstein J. E., Swift R. Relief of intractable pruritus with naloxone. Arch Dermatol. 1979 Nov;115(11):1366–1367. [PubMed] [Google Scholar]
  9. Chauvin M., Samii K., Schermann J. M., Sandouk P., Bourdon R., Viars P. Plasma concentration of morphine after i.m., extradural and intrathecal administration. Br J Anaesth. 1981 Sep;53(9):911–913. doi: 10.1093/bja/53.9.911. [DOI] [PubMed] [Google Scholar]
  10. Collier C. B. Epidural morphine. Anaesthesia. 1981 Jan;36(1):67–67. doi: 10.1111/j.1365-2044.1981.tb08608.x. [DOI] [PubMed] [Google Scholar]
  11. Di Chiro G. Observations on the circulation of the cerebrospinal fluid. Acta Radiol Diagn (Stockh) 1966;5:988–1002. doi: 10.1177/02841851660050p242. [DOI] [PubMed] [Google Scholar]
  12. Duffy B. L. Itching as a side-effect of epidural morphine. Anaesthesia. 1981 Jan;36(1):67–67. doi: 10.1111/j.1365-2044.1981.tb08609.x. [DOI] [PubMed] [Google Scholar]
  13. Hales P. Pruritus after epidural morphine. Lancet. 1980 Jul 26;2(8187):204–204. doi: 10.1016/s0140-6736(80)90090-2. [DOI] [PubMed] [Google Scholar]
  14. Herndon J. H., Jr Itching: the pathophysiology of pruritus. Int J Dermatol. 1975 Sep;14(7):465–484. doi: 10.1111/j.1365-4362.1975.tb04281.x. [DOI] [PubMed] [Google Scholar]
  15. Holdsworth J. D., Roulston R. G. An unusually high block following intrathecal bupivacaine. Anaesthesia. 1982 Mar;37(3):347–348. doi: 10.1111/j.1365-2044.1982.tb01123.x. [DOI] [PubMed] [Google Scholar]
  16. Jurna I., Grossman W. The effect of morphine on the activity evoked in ventrolateral tract axons of the cat spinal cord. Exp Brain Res. 1976 Mar 15;24(5):473–484. doi: 10.1007/BF00234964. [DOI] [PubMed] [Google Scholar]
  17. Jurna I., Heinz G. Differential effects of morphine and opioid analgesics on A and C fibre-evoked activity in ascending axons of the rat spinal cord. Brain Res. 1979 Aug 10;171(3):573–576. doi: 10.1016/0006-8993(79)91065-5. [DOI] [PubMed] [Google Scholar]
  18. Jørgensen B. C., Andersen H. B., Engquist A. Csf and plasma morphine after epidural and intrathecal application. Anesthesiology. 1981 Dec;55(6):714–715. [PubMed] [Google Scholar]
  19. Kimball C. D., Chang C. M., Huang S. M., Houck J. C. Immunoreactive endorphin peptides and prolactin in umbilical vein and maternal blood. Am J Obstet Gynecol. 1981 May 15;140(2):157–164. doi: 10.1016/0002-9378(81)90103-4. [DOI] [PubMed] [Google Scholar]
  20. Kimball C. D. Do endorphin residues of beta lipotropin in hormone reinforce reproductive functions? Am J Obstet Gynecol. 1979 May 15;134(2):127–132. doi: 10.1016/0002-9378(79)90875-5. [DOI] [PubMed] [Google Scholar]
  21. Mathews E. Epidural morphine. Lancet. 1979 Mar 24;1(8117):673–673. doi: 10.1016/s0140-6736(79)91121-8. [DOI] [PubMed] [Google Scholar]
  22. McQuay H. J., Bullingham R. E., Evans P. J., Lloyd J. W., Moore R. A. Demand analgesia to assess pain relief from epidural opiates. Lancet. 1980 Apr 5;1(8171):768–769. doi: 10.1016/s0140-6736(80)91263-5. [DOI] [PubMed] [Google Scholar]
  23. Mok M. S., Tsai S. K. More experience with intrathecal morphine for obstetric analgesia. Anesthesiology. 1981 Oct;55(4):481–481. [PubMed] [Google Scholar]
  24. RIESELBACH R. E., DI CHIRO G., FREIREICH E. J., RALL D. P. Subarachnoid distribution of drugs after lumbar injection. N Engl J Med. 1962 Dec 20;267:1273–1278. doi: 10.1056/NEJM196212202672502. [DOI] [PubMed] [Google Scholar]
  25. Reiz S., Westberg M. Side-effects of epidural morphine. Lancet. 1980 Jul 26;2(8187):203–204. doi: 10.1016/s0140-6736(80)90089-6. [DOI] [PubMed] [Google Scholar]
  26. Rosow C. E., Moss J., Philbin D. M., Savarese J. J. Histamine release during morphine and fentanyl anesthesia. Anesthesiology. 1982 Feb;56(2):93–96. doi: 10.1097/00000542-198202000-00003. [DOI] [PubMed] [Google Scholar]
  27. Russell I. F. Intrathecal bupivacaine 0.5% for Caesarean section. Anaesthesia. 1982 Mar;37(3):346–347. doi: 10.1111/j.1365-2044.1982.tb01122.x. [DOI] [PubMed] [Google Scholar]
  28. Scott P. V., Bowen F. E., Cartwright P., Rao B. C., Deeley D., Wotherspoon H. G., Sumrein I. M. Intrathecal morphine as sole analgesic during labour. Br Med J. 1980 Aug 2;281(6236):351–353. doi: 10.1136/bmj.281.6236.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Scott P. V., Fischer H. B. Intraspinal opiates and itching: a new reflex? Br Med J (Clin Res Ed) 1982 Apr 3;284(6321):1015–1016. doi: 10.1136/bmj.284.6321.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Snyder S. H. Opiate receptors and internal opiates. Sci Am. 1977 Mar;236(3):44–56. doi: 10.1038/scientificamerican0377-44. [DOI] [PubMed] [Google Scholar]
  31. Snyder S. H. Opiate receptors in the brain. N Engl J Med. 1977 Feb 3;296(5):266–271. doi: 10.1056/NEJM197702032960511. [DOI] [PubMed] [Google Scholar]
  32. Spinal analgesia using bupivacaine 0.5%. Anaesthesia. 1982 Jan;37(1):91–92. doi: 10.1111/j.1365-2044.1982.tb01018.x. [DOI] [PubMed] [Google Scholar]
  33. Summerfield J. A. Pain, itch and endorphins. Br J Dermatol. 1981 Dec;105(6):725–726. doi: 10.1111/j.1365-2133.1981.tb00985.x. [DOI] [PubMed] [Google Scholar]
  34. WHITE J. C., SWEET W. H., HAWKINS R., NILGES R. G. Anterolateral cordotomy: results, complications and causes of failure. Brain. 1950;73(3):346–367. doi: 10.1093/brain/73.3.346. [DOI] [PubMed] [Google Scholar]
  35. Welchew E. A., Thornton J. A. Continuous thoracic epidural fentanyl. A comparison of epidural fentanyl with intramuscular papaveretum for postoperative pain. Anaesthesia. 1982 Mar;37(3):309–316. doi: 10.1111/j.1365-2044.1982.tb01105.x. [DOI] [PubMed] [Google Scholar]
  36. Weston P. G. Sugar Content of the Blood and Spinal Fluid of insane Subjects. J Med Res. 1916 Nov;35(2):199–208. [PMC free article] [PubMed] [Google Scholar]
  37. Yaksh T. L., Reddy S. V. Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. Anesthesiology. 1981 Jun;54(6):451–467. doi: 10.1097/00000542-198106000-00004. [DOI] [PubMed] [Google Scholar]
  38. Yaksh T. L. Spinal opiate analgesia: characteristics and principles of action. Pain. 1981 Dec;11(3):293–346. doi: 10.1016/0304-3959(81)90633-3. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES