Initial Intrathecal Dose Titration and Predictors of Early Dose Escalation in Patients With Cancer Using a 100:1 Oral to Intrathecal Morphine Conversion Ratio

Sindt, Jill E.; Odell, Daniel W.; Tariq, Rayhan; Presson, Angela P.; Zhang, Chong; Brogan, Shane E.

doi:10.1111/ner.13517

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…Although it has been argued that trials are useful for the identification of appropriate starting doses after implant, improved initial dosing strategies, as well the advent of patient-controlled intrathecal analgesia has permitted rapid and safe attainment of effective intrathecal dosing without the need of a laborious dose-finding process 44…”

Section: Trialing In Cancer Painmentioning

confidence: 99%

Controversies in intrathecal drug delivery for cancer pain

Brogan

Sindt

Odell

et al. 2022

Reg Anesth Pain Med

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Pain and suffering related to cancer are challenging issues that continue to deserve consideration for treatment optimization. Advances in analgesic management and control of the underlying cancer have improved symptom management, yet many patients still suffer from uncontrolled pain. Intrathecal drug delivery has an established role in the management of refractory cancer pain, but there are significant knowledge gaps in our understanding and application of this therapy. This review addresses several areas of controversy, including the importance of intrathecal catheter tip location, the necessity of an intrathecal trial and the role of intrathecal ziconotide and local anesthetics. In each area, the evidence is discussed, with an emphasis on presenting practical clinical guidance and highlighting deficiencies in our knowledge that are worthy of future investigation.

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Section: Trialing In Cancer Painmentioning

confidence: 99%

Controversies in intrathecal drug delivery for cancer pain

Brogan

Sindt

Odell

et al. 2022

Reg Anesth Pain Med

Self Cite

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“…Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) is utilized in the treatment of refractory spasticity and intractable pain of cancer and non-cancer origin. [1][2][3][4][5][6][7] IDDS consist of an intrathecal spinal catheter connected to a pump reservoir delivering prescribed medication into the subarachnoid space (Figure 1). The two current generation intrathecal pumps that are commonly utilized are the Medtronic SynchroMed TM II and the Flowonix Prometra II (Figure 2).…”

Section: Introductionmentioning

confidence: 99%

Education and Experience in Intrathecal Drug Delivery Systems (IDDS) During Pain Medicine Fellowships

Mahmoud,

Aman,

Trumbo

et al. 2023

JPR

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Objective Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training. Materials and Methods An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021–2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies. Results Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers. Conclusion A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows’ education.

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