Probst C
Neurochirurgische Klinik, Kantonsspital Aarau.
Schweiz Rundsch Med Prax. 1991 Nov 12;80(46):1278-82.
The significance of the demand-controlled spinal and cerebral administration of morphine has increased with the improvements in the variable techniques (including programmable implanted pumps). Continuous low-dose infusion enables sustained pain-free state with minimal risks and side effects, so that this method is also feasible for treatment of very severe therapy-resistant pain in benign conditions. Neurostimulation of the lemniscal system (dorsal columns of the spinal cord, specific thalamus, etc., especially in deafferentation pain) and surgical interruption of pain pathways and centers (especially in nociceptive pain) as a last resort continue to be indispensable. In our view, the assumption that spinal and cerebral application of morphine is not appropriate in deafferentation pain is not justified on the basis of the most recent discussions and our own observations. Merely higher doses are probably required for this type of pain.
随着可变技术（包括可编程植入泵）的改进，按需控制的脊髓和脑内吗啡给药的重要性日益增加。持续低剂量输注能够在风险和副作用最小的情况下实现持续无痛状态，因此该方法对于治疗良性疾病中非常严重的难治性疼痛也是可行的。作为最后手段，对lemniscal系统（脊髓背柱、特定丘脑等，特别是在去传入性疼痛中）进行神经刺激以及对疼痛通路和中枢进行手术阻断（特别是在伤害感受性疼痛中）仍然是不可或缺的。在我们看来，基于最近的讨论和我们自己的观察，认为脊髓和脑内应用吗啡不适用于去传入性疼痛的假设是没有道理的。对于这类疼痛，可能仅需要更高的剂量。
