Implantable Intrathecal Pumps for the Treatment of Noncancer Chronic Pain in Elderly Population: Drug Dose and Clinical Efficacy

The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks

“…In one study, catheter migration was reported in 7.3% of cases, catheter tear in 6.4% and catheter occlusion in 1.8% . Catheter‐related problems occurred in 7.4% (28/380) of patients in an older large retrospective study, with total delivery system complications occurring in 21.6% (82/380) . A recent study of 57 patients with lumbar postlaminectomy syndrome, trialed, implanted and managed for 24 months with hydromorphone/bupivacaine by a single implanter, revealed a total of 36 catheter dye studies on 29 patients .…”

Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

“…Combination Therapy In the previously described study that included 32 patients with chronic noncancer pain who were treated with IT morphine and bupivacaine combination therapy (see morphine section) (92), VAS pain scores decreased significantly from baseline to Month 3 ( p < 0.01) and remained consistently reduced through the 48‐month follow‐up. Additionally, a prospective, open‐label pilot study was conducted to evaluate the stability and tolerability of high‐dose bupivacaine (4–21.4 mg/day) in 12 patients already receiving IT opioids and low‐dose bupivacaine (165).…”

“…Significant reductions in pain intensity, along with significant decreases in the mean systemic opioid dose, were noted at one and three months after initiation of IT therapy and up to the time of death ( p ≤ 0.029). In another open‐label study, one that included 32 patients with chronic noncancer pain who had >70% pain relief after a trial of low‐dose IT morphine and bupivacaine, continuous IT therapy (0.1 mg/day morphine, 0.5 mg/day bupivacaine) was initiated, and dosages were titrated to a mean of 1.03 mg/day morphine and 1.15 mg/day bupivacaine (92). Mean VAS pain scores decreased significantly from baseline to Month 3 ( p < 0.01) and remained consistently reduced through the 48‐month follow‐up.…”

Long-term intrathecal morphine and bupivacaine upregulate MOR gene expression in lymphocytes

“…The use of IT bupivacaine for the treatment of non-cancer chronic pain is also widely acknowledged because it has no bone marrow toxicity and has positive synergy with opioids, acting on different nociceptive circuits [5]. Moreover, the association of bupivacaine with morphine in IT therapy allows lower doses of morphine to be used, thereby reducing the incidence of opioid-related side effects [7,8].…”

“…Recently, there has been increasing use of intrathecal (IT) morphine for pain control in patients who do not respond to traditional methods of drug administration or who cannot tolerate high doses of orally administered opioids because of the onset of systemic side effects [5].…”