The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain.

BACKGROUND: Intrathecal drug delivery has undergone a revitalization following a better understanding of this delivery route and its pharmacokinetics. Driven by patient safety and outcomes, clinicians are motivated to rethink the traditional spinal infusion pump patient selection criteria and indications. We review the current understanding of the pharmacology of commonly employed intrathecal agents and the clinical relevance. METHODS: Search strategies for data acquisition included Medline database, PubMed, Google scholar, along with international and national professional meeting content, with key words including pharmacology of opioids, intrathecal therapy, ziconotide, pharmacokinetics, and intrathecal drug delivery. The search results were limited to the English language. RESULTS: Over 300 papers were identified. The literature was condensed and digested to evaluate the most commonly used medications in practice, sto serve as a foundation for review. We review on-label medications: ziconotide and morphine, and off label medications including fentanyl, sufentail, and hydromorphine. CONCLUSION: Intrathecal therapy has level-one evidence for use for malignant pain and nonmalignant pain, with continued cost savings and improved safety. To most effectively serve our patients, a clear appreciation for the pharmacology of these commonly employed medication is paramount.

Schizophrenia and birth order in Pakistan.

The paper describes a two stage study. In Stage I the birth orders of 453 adult patients with different diagnoses, seen in the routine work of a general hospital psychiatry department, were compared. Patients with schizophrenia had significantly higher average birth positions than patients with other diagnoses, even after controlling for sibship size.In Stage II, the birth positions of 64 patients with schizophrenia (DSMIIIR) were subjected to a goodness-of-fit chi-square test. Over-representation of eldest siblings was highly significant for both sexes. When patients aged 30 and above were analysed separately, there was still a significant excess of first-born. These findings are in contrast to birth order studies of schizophrenia in western populations. In the authors' opinion, they can not be accounted for by the biases to which birth order studies are prone. They indicate a need for further community-based studies.