Wang, Josef K.

Morphine sulfate, a narcotic analgesic, possesses the undesirable side effects of central depression, tolerance, and dependency. Opiate receptors have been found in the brain and the spinal cord. Intrathecally applied opiates produce potent analgesia that can be antagonized by naloxone. The time-response study with tail-flick response after intrathecal injections of a small dosage of morphine (25 μg) demonstrated a long-lasting analgesia. Intrathecal injections of morphine or opiate-like peptides may become a predictable modality of pain relief without attendant loss of other neurologic function.

During a 3-year period, 51 patients with upperextremity reflex sympathetic dystrophy were studied. Of 20 patients managed by conservative methods, nine (45%) showed signs of improvement 3 years after onset of the syndrome. Of 31 patients treated with repeated stellate ganglion blocks, 23 (74%) had improved at the 3-year evaluation. Management of both the potential causes and the symptoms of reflex sympathetic dystrophy is necessary. Although sympathetic blocks failed to improve all cases, they should be considered as one of the important methods for the management of reflex sympathetic dystrophy.