Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Abstract

Background: This retrospective study analyzed data among a single-center cohort of patients at a university hospital center designed as an Institutional Review Board (IRB)-approved retrospective chart review to assess the outcomes associated with intrathecal pump (ITP) placement in patients with severe abdominal pain from chronic pancreatitis. Objectives: Examine ITP therapy as an alternative form of analgesia for chronic pancreatitis. Study Design: A retrospective analysis. Setting: The pain management department at the University of Toledo. Methods: The primary outcomes assessed oral narcotic requirement, visual analog scale (VAS) pain scores, and the number of hospital admissions, with the outcome assessments taken pre-ITP placement and 1, 6, 12, and 24 months post-ITP placement. Results: A total of 8 patients, with a mean age of 44.6 years, who underwent ITP placement following failed conservative therapies for abdominal pain from chronic pancreatitis were reviewed. A reduction in pain level average (VAS) was noted from pre-ITP placement (VAS = 8.38, SD = 1.49) to post-ITP placement at 1 month (VAS = 4.85, SD = 2.20, P = 0.0127), 6 months (VAS = 4.43, SD = 2.50, P = 0.0134), 12 months (VAS = 3.67, SD = 2.36, P = 0.0112), and 24 months (VAS = 4.8, SD = 2.63, P = 0.0459). A reduction in mean hospitalizations (MH) post-ITP was noted from pre-ITP placement (MH = 9.25, SD = 11.12) to post-placement at 1 month (MH = 0, SD = 0, P = 0.0637), 6 months (MH = 0.125, SD = 0.33, P = 0.1403), 12 months (MH = 0.167, SD = 0.37, P = 0.1502), and 24 months (MH = 0.2, SD = 0.4, P = 0.1457). A reduction in mean oral morphine sulfate equivalents (MEq) occurred from pre-ITP placement (MEq = 293.98, SD = 302.99) to post- ITP placement at 1 month (MEq = 11.025, SD = 19.35, P = 0.0369), 6 months (MEq = 14.4, SD = 19.55, P = 0.0578), 12 months (MEq = 19.95, SD = 24.24, P = 0.0542), and 24 months (MEq = 17.64, SD = 29.38, P = 0.0896). Limitations: The small sample size and the retrospective nature of this study prove to be 2 major limitations. Conclusions: Statistically significant improvements in postoperative pain levels across all of the time intervals post-ITP, in addition to large gross reductions in MH and MEq, collectively yield promising results for ITP therapy as an alternative treatment modality for chronic abdominal pain in patients with chronic pancreatitis. Key words: Intrathecal pump, intrathecal therapy, chronic pancreatitis, abdominal pain, chronic pain, analgesic effectiveness