Research – Intrathecal Pumps

** click the blue article titles below for the abstracts
note: recent additions will be added to the top of the list

12 – Intrathecal hydromorphone for intractable nonmalignant pain: a retrospective study

• Pain Med. 2006 Jan-Feb;7(1):10-5.

Retrospective review of 24 patients using intrathecal hydromorphone as a solo analgesic

Average pain scores decreased significantly

11 – Implantable drug delivery systems (IDDS) after failure of comprehensive medical management (CMM) can palliate symptoms in the most refractory cancer pain patients

• J Palliat Med. 2005 Aug;8(4):736-42.

Randomized clinical trial (30 patients) to evaluate whether IDDS could help the most refractory patients failed by expert CMM

Pain scores reduced by 27%

Survival time of 3 months may be long enough for the IDDS implant to be cost effective.

Patients with refractory cancer pain, whom failed expert comprehensive medical management with high-dose opioids, derived benefit from IDDS.

10 – Pain management, including intrathecal pumps

• Curr Pain Headache Rep. 2005 Aug;9(4):243-8.

Review

Randomized trial of 202 patients with pain scores of 7.5 or higher.

IDDS vs CMM: Pain scores reduced = 52% vs 39%;  Drug toxicity scores reduced = 50% vs 17%;  IDDS patients lived longer

Randomized trial of 30 patients

IDDS in patients who failed CMM: Pain scores reduced = 27%

9 – Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain

• Pain Med. 2004 Mar;5(1):6-13.

166 patients trialed;  136 patients implanted

Pain scores reduced:  47% for low back pain;  31% for leg pain [at 12 months]

Oswestry scores reduced at least one level in 65% of patients [at 12 months]

Satisfaction:  85%

8 – Management of chronic intractable angina – spinal opioids offer an alternative therapy

• Pain. 2003 Mar;102(1-2):163-6.

7 patients who failed prior cardiac surgeries

Bolus doses of either morphine or fentanyl into either the epidural (2) or intrathecal (5) spaces

Viable alternative for patients who have failed traditional management

7 – Successful treatment of restless legs syndrome with an implanted pump for intrathecal drug delivery

• Acta Anaesthesiol Scand. 2002 Jan;46(1):114-7.

2 patients who failed conventional care with dopaminergic drugs

Intrathecal delivery of morphine and bupivacaine

Total resolution of all symptoms with few side effects

6 – Managing chronic nonmalignant pain with continuous intrathecal morphine

• J Neurosci Nurs. 1998 Aug;30(4):233-9, 243-4.

12 patients followed for one year

Pain relief of 42% (on the McGill pain questionnaire)

Subjective improvement in ADLs.  One patient returned to work.

Complications of implantation occurred in 33.3% of the patients and were successfully managed without discontinuing therapy.

5 – Intrathecal morphine pump as a treatment option in chronic pain of nonmalignant origin

• Surg Neurol. 1998 Jan;49(1):92-8; discussion 98-9.

11 patients with either failed back syndrome (9) or neuropathic pain (2) of other causes

Up to 3-year follow-up

Good to excellent pain relief in 73%

Two patients experienced bladder dysfunction requiring pump removal.

4 – Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome

• Clin Ther. 1997 Jan-Feb;19(1):96-112; discussion 84-5.

Even taking the cost of complications and pump replacement into consideration, intrathecal morphine therapy appears to be cost-effective when compared with medical management for selected patients when the duration of therapy exceeds 12 to 22 months.

3 – Intrathecal administration of morphine and bupivacaine in the treatment of severe pain in chronic pancreatitis

• Ned Tijdschr Geneeskd. 1996 Jul 6;140(27):1410-2.

Case report of a patient with severe pain from chronic pancreatitis (patient had failed numerous medical and surgical therapies)

Adequate pain relief was achieved with intrathecal morphine and bupivacaine

2 – Intrathecal infusion systems for treatment of chronic low back and leg pain of noncancer origin

• South Med J. 1996 Mar;89(3):295-300.

26 patients with an average follow-up of 23 months

Pain relief (good to excellent) in 77%

Daily functioning increased 50%

9 catheter complications

1 – Long term treatment of intractable reflex sympathetic dystrophy with intrathecal morphine

• Can J Neurol Sci. 1995 May;22(2):153-9.

2 patients with intractable leg pain, swelling and autonomic changes after a leg injury.  Failed medical and surgical options (sympathectomies)

Relatively satisfactory symptom control.  Temporary increases in morphine dose was used for exacerbations.