Intrathecal drug delivery for the management of pain and spasticity in adults: an executive summary of the British Pain Society’s recommendations for best clinical practice

Duarte, Rui; Raphael, Jacob; Eldabe, Sam

doi:10.1177/2049463715587747

Cited by 19 publications

(12 citation statements)

References 7 publications

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“…Ankur D. Mehta, DO 1 , Mitchell P. Engle, MD 2 , and Vishal Bansal, MD 3 Intrathecal drug delivery systems are effective tools in the treatment of chronic pain or spasticity. Using intrathecal drug delivery systems, drugs are directly infused into the cerebrospinal fluid and gain access to critical receptors in the central nervous system.…”

Section: Use Of Color Flow Doppler Ultrasonography To Increase the Safety Of Intrathecal Drug Delivery System Refillsmentioning

confidence: 99%

Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

Mehta¹

2019

PMCR

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Intrathecal drug delivery systems are effective tools in the treatment of chronic pain or spasticity. Using intrathecal drug delivery systems, drugs are directly infused into the cerebrospinal fluid and gain access to critical receptors in the central nervous system. This delivery method allows for the use of markedly reduced doses of medications to produce the same effects as seen with higher orally administered doses. Reduced dosing produces fewer side effects, creating a more favorable treatment course for patients already suffering from chronic pain or spasticity. Complications with intrathecal drug delivery systems can occur during both the implantation process and the postoperative maintenance of the device. The most common procedure carried out during postoperative maintenance of these devices is the intrathecal pump refill. This procedure must be performed by experienced practitioners in a systematic way in order to prevent complications. The most dreaded of these complications is inadvertent injection of medication into the subcutaneous space as opposed to into the device, commonly referred to as a “pocket fill.” This paper describes and recommends the routine use of color flow doppler ultrasonography as an easy, safe, and effective tool to reduce the chance of a catastrophic “pocket fill.” Routine utilization of live color flow ultrasound guidance during pump refills allows the practitioner to carefully document flow of medication into the pump under the silicone septum. It also allows for demonstration of no leakage from, or fluid increase superficial to, the septum. Additionally, 2 ultrasound images are obtained to document color flow deep to the septum and no color flow/leak/fluid superficial to the septum. Although this complication is rare, it can lead to severe complications including oversedation, respiratory depression, and death. As such, we believe that the utilization of color phase doppler ultrasonography could further reduce this incidence. Key words: Analgesics, opioids, chronic pain, drug overdose, infusion pumps, implantable, injections, spinal, medication errors, spasticity, ultrasonics, methods, ultrasonography, interventional

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Section: Use Of Color Flow Doppler Ultrasonography To Increase the Safety Of Intrathecal Drug Delivery System Refillsmentioning

confidence: 99%

Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

Mehta¹

2019

PMCR

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“…На основании всей доступной к настоящему времени ин-формации можно заключить, что морфин является наиболее из-ученным препаратом, рекомендуемым к использованию для ин-тратекальной терапии благодаря его стабильности, высокой аф-финности к узкому кругу рецепторов, низкой стоимости, неболь-шой частотой побочных эффектов, [25,26].…”

Section: обзоры литературыunclassified

Long-term intrathecal opioid therapy using implantable programmable devices in the treatment of resistant chronic pain syndrome

Зайцев¹,

Абузарова²,

Куржупов³

et al. 2016

Onkol. Z. im. P.A. Gercena

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Московский научно-исследовательский онкологический институт им. П.А. Герцена -филиал ФГБу «национальный медицинский исследовательский радиологический центр» Минздрава россии, Москва, россия в обзоре обобщен материал зарубежных авторов и собственные исследования по длительной интратекальной опиоидной терапии с использованием имплантируемых программируемых устройств в лечении резистентного хронического болево-го синдрома (ХБС). Показано, что метод длительной интратекальной опиоидной терапии высокоэффективен в отношении ХБС как онкологического, так и неонкологического генеза и позволяет существенно улучшить качество жизни больных.Ключевые слова: хронический болевой синдром, онкологическая боль, интратекальная терапия. Long-term intrathecal opioid therapy using implantable programmable devices in the treatment of resistant chronic pain syndromeA.m. zAITSev, G.r. ABuzArovA, m.I. KurzhuPov, r.r. SArmAnAevA, e.A. PoTAPovA, o.n. KIrSAnovA P.A. herzen moscow oncology research Institute, Branch, national medical radiology research center, ministry of health of russia, moscow, russiaThe review summarizes the material obtained by foreign authors and presents the investigations conducted by the authors of this paper to study long-term intrathecal opioid therapy using implantable programmable devices in the treatment of resistant chronic pain syndrome (cPS). long-term intrathecal opioid therapy is shown to be highly effective in treating cancer-and noncancerrelated cPS and to substantially improve quality of life in patients.

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“…Spinal cord stimulation (SCS) and intrathecal drug delivery (ITDD) have been seen as “last resort” options and are typically made available to patients who have experienced prolonged periods of pain, sometimes as long as 40 years . ITDD is used for the management of cancer and noncancer pain, and for spasticity . There are different levels of evidence for the use of ITDD in these different conditions .…”

Section: Introductionmentioning

confidence: 99%

Intrathecal Drug Delivery Systems for the Management of Chronic Noncancer Pain: A Systematic Review of Economic Evaluations

et al. 2017

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Introduction: Intrathecal drug delivery (ITDD) systems are an option for the management of patients with chronic non-cancer pain, cancer pain and spasticity. Concerns over their invasiveness and high initial costs have led National Health Service (NHS) England to decommission ITDD for patients with chronic noncancer pain. However, the extent to which this decision is in line with existing economic evidence is unclear.To address this question, we will carry out a systematic review to identify and evaluate the existing evidence on the cost-effectiveness of ITDD for chronic non-cancer pain.Methods and analysis: A high-sensitivity search strategy will be employed in Cochrane Library, MEDLINE, EMBASE, Web of Science, NHS EED, DARE and HTA. Database searches will be complemented by additional searching techniques. Screening of the results will be performed by 2 reviewers independently using predetermined inclusion and exclusion criteria. Full and partial economic evaluations will be included. Data extraction will be carried out using a form created for the purposes of this review. Quality assessment of all included studies will be performed using recommended checklists.Ethics and dissemination: Ethical approval is not required as primary data will not be collected. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number:CRD42016035266.

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Intrathecal drug delivery for the management of pain and spasticity in adults: an executive summary of the British Pain Society’s recommendations for best clinical practice

Abstract: This article provides a summary of the updated British Pain Society Guidance on Intrathecal Drug Delivery for the management of pain and spasticity in adults. We aim to highlight the areas of the guidance that have been updated and to provide a concise summary.

Cited by 19 publications

References 7 publications

Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

Long-term intrathecal opioid therapy using implantable programmable devices in the treatment of resistant chronic pain syndrome

Intrathecal Drug Delivery Systems for the Management of Chronic Noncancer Pain: A Systematic Review of Economic Evaluations

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