A Review of Intrathecal Fentanyl and Sufentanil for the Treatment of Chronic Pain

Waara-Wolleat, Kelley L.; Hildebrand, Keith R.; Stewart, Gregory R.

doi:10.1111/j.1526-4637.2006.00155.x

Cited by 51 publications

(41 citation statements)

References 40 publications

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“…42 Fentanyl has greater intrinsic activity (i.e., amount of response per opioid-receptor complex) compared with morphine; therefore, fentanyl interacts with fewer opioid receptors than does morphine to produce an equianalgesic response. Fentanyl may offer a distinct advantage for chronic intrathecal therapy by producing less tolerance due to the lower receptor activation.…”

Section: 24 Commonmentioning

confidence: 99%

“…Further studies are needed to support the long-term use of fentanyl for chronic nonmalignant pain. 42 The adverse-effect profile for opioids is influenced by pharmacologic properties, the duration of therapy, and the dose. For all opioids, common adverse effects reported following a single intrathecal injection include urinary retention, nausea, vomiting, and pruritus.…”

Section: 24 Commonmentioning

confidence: 99%

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Intrathecal drug therapy for long-term pain management

Ghafoor

Epshteyn²,

Carlson

et al. 2007

American Journal of Health-System Pharmacy

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The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.

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Section: 24 Commonmentioning

confidence: 99%

Section: 24 Commonmentioning

confidence: 99%

Intrathecal drug therapy for long-term pain management

Ghafoor

Epshteyn²,

Carlson

et al. 2007

American Journal of Health-System Pharmacy

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“…However, morphine, which is commonly used as the medication in the intrathecal device, has significant side effects which limit its usefulness. A promising alternative to morphine is Sufentanil, but there are few clinical reports on the safety, toxicology, and stability of its pH available to support its use in chronic pain [5]. This is an off-label use of Sufentanil.…”

mentioning

confidence: 99%

The Long-Term Safety and Efficacy of Intrathecal Therapy Using Sufentanil in Chronic Intractable Non-Malignant Pain

Monsivais

2014

Korean J Pain

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This report describes the long term safety and efficacy of intrathecal therapy using Sufentanil for the management of chronic intractable neuropathic pain in 12 chronic pain patients. Standardized psychological screening was used to determine treatment suitability. Evaluation data included the Visual Analog Scale (VAS), Wong-Baker Faces Scale, Brief Pain Inventory (BPI), Disability of Arm, Shoulder, and Hand (DASH), McGill Quality of Life Questionnaire, and complications (granulomas, toxicity, withdrawal, or deaths). SPSS version 18 was used for data analysis. Pre- and post- treatment BPI measures and pain scale scores showed a statistically significant difference. There were no complications directly related to drug toxicity, nor drug withdrawals, granulomas, or deaths. Intrathecal therapy with Sufentanil therapy offers a good treatment alternative for those cases that have failed both surgery and standard pain treatment. Strict patient selection based on psychological screening, control of co-morbidities, a proper pain management may contribute to successful outcome.

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“…Inflammatory masses have been reported with intrathecal administration of all medications except sufentanil and rarely with fentanyl. 26,28 Through returned product analysis and in vitro testing, Medtronic Neuromodulation has confirmed "nonindicated drugs" that result in intrathecal catheter occlusion include compounded medication of baclofen and morphine, admixtures of baclofen with clonidine, baclofen mixed with other drugs, and admixtures for chronic pain therapy containing morphine, baclofen, hydromorphone, clonidine, bupivacaine, fentanyl, and/or sufentanil. § The propagation of the inflammation with mast cell degranulation, histamine release, and other inflammatory mediators results in the mass formation.…”

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confidence: 99%

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

2011

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INTRATHECAL drug delivery systems are frequently used to treat chronic pain and spasticity conditions. One of the first clinical uses of an implantable intrathecal opioid delivery device occurred in 1981 for the management of chronic malignant pain, 1 although trials of opioids for intractable cancer pain began with Wang in 1979.2 Initially utilized as a means of pain amelioration in cancer patients, intrathecal therapy now has indications that have expanded to include nonmalignant chronic pain conditions.3-6 Opioids are often utilized as an infusion agent, with the principal advantage of intrathecal delivery near the site of action within the central nervous system, increasing the therapeutic efficacy, and thus reducing the likelihood of side effects associated with other delivery modalities. The implementation of intrathecal drug delivery systems has shown efficacy in many pain states, 7,8 but complications or adverse effects may arise. Aprili et al., in a recent systematic review and metaanalysis, examined the potential risks of intrathecal catheters in cancer patients and reported rates of 2.3% (95% CI, 0.8 -6.1) and 1.4% (95% CI, 0.5-3.8) for superficial and deep infections, respectively; bleeding was found to be 0.9% (95% CI, 0 -2.0) and neurologic injury 0.4% (95% CI, 0 -1.0). 9The most significant adverse event of mortality can be associated with intrathecal opioids, and mortality rates have been reported of 0.088% at 3 days after implantation, 0.39% at 1 month, and 3.89% at 1 yr, a higher mortality rate than after spinal cord stimulation implants or after lumbar discectomy in community hospitals. 10 The purpose of presenting this case is to highlight key points essential for the diagnosis and treatment of intrathecal granulomatous masses and the vigilance required by physicians managing patients with intrathecal drug delivery systems. Case ReportA 38-yr-old female registered nurse presented to the pain medicine clinic for continued management of her chronic thoracic spine pain and possible malfunction of her intrathecal drug delivery system. The patient's past medical history was significant for depression, anterior cervical discectomy with fusion, and a SynchroMed EL Infusion Pump (Medtronic Neurologic, Minneapolis, MN) placement for chronic pain related to T4 and T5 vertebral hemangiomas. The intrathecal pump was placed 9 months before her initial visit in our clinic. She was previously evaluated by multiple pain medicine specialists, with failure to attenuate her pain complaint. Upon initial evaluation she was receiving 40 mg/ day of intrathecal morphine at a concentration of 50 mg/ml. At implantation she began therapy at 10 mg/day (20 mg/ml) but escalated to 40 mg/day. The high concentration, daily dose, and lack of analgesia prompted further evaluation of the system, which included cannulation of the catheter access port to evaluate patency of the intrathecal catheter. A lack of cerebral spinal fluid back-flow necessitated further evaluation, which included a catheter-access-port myelogram showing ...

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A Review of Intrathecal Fentanyl and Sufentanil for the Treatment of Chronic Pain

Cited by 51 publications

References 40 publications

Intrathecal drug therapy for long-term pain management

Intrathecal drug therapy for long-term pain management

The Long-Term Safety and Efficacy of Intrathecal Therapy Using Sufentanil in Chronic Intractable Non-Malignant Pain

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

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