Intrathecal Hydromorphone for Chronic Nonmalignant Pain: A Retrospective Study

Anderson, Valerie C.; Cooke, Beverly; Burchiel, Kim J.

doi:10.1046/j.1526-4637.2001.01052.x

Cited by 64 publications

(47 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among these, 52 articles were excluded from both the effectiveness and complications review based on the same criterion: 26 because they were case reports ; 13 because they did not report data separately for patients with programmable IDDS, 39-51 9 because >10% of the sample had spasticity or a specific disease [52][53][54][55][56][57][58][59][60] ; and 4 because they focused only on patients who had not responded to their first IDDS drug. [61][62][63][64] (Where there was more than 1 reason for exclusion, we noted only the first reason identified.) Twenty other articles were excluded from the effectiveness review; 14 because they did not meet the study methodology criteria 65-78 and 6 because they did not report pre-IDDS data on pain or functioning.…”

Section: Search Resultsmentioning

confidence: 99%

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Turner¹,

Sears

Loeser

2007

The Clinical Journal of Pain

140

120

View full text Add to dashboard Cite

The studies reviewed found improvement in pain and functioning on average among patients with chronic noncancer pain who received permanent IDDS. However, their methodologic limitations preclude conclusions concerning the effectiveness of this technology long-term and as compared with other treatments. Drug side effects and hardware complications were common. Suggestions are made for methodologic improvements in future studies.

show abstract

Section: Search Resultsmentioning

confidence: 99%

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Turner¹,

Sears

Loeser

2007

The Clinical Journal of Pain

140

120

View full text Add to dashboard Cite

show abstract

“…Anderson et al reported 25% improvement in pain control in a group of cancer patients who had inadequate analgesia from morphine. They also reported a significant reduction in side effects such as nausea, vomiting, pruritus and sedation with hydromorphone vs. morphine [59]. Peripheral edema has been reported, similar to morpine [61].…”

Section: Commonly Used Agents Not Currently Labeled For Intrathecal Usementioning

confidence: 99%

The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain

Pope¹,

Deer²,

Amirdelfan³

et al. 2017

View full text Add to dashboard Cite

BackgroundIntrathecal drug delivery has undergone a revitalization following a better understanding of this delivery route and its pharmacokinetics. Driven by patient safety and outcomes, clinicians are motivated to rethink the traditional spinal infusion pump patient selection criteria and indications. We review the current understanding of the pharmacology of commonly employed intrathecal agents and the clinical relevance.MethodsSearch strategies for data acquisition included Medline database, PubMed, Google scholar, along with international and national professional meeting content, with key words including pharmacology of opioids, intrathecal therapy, ziconotide, pharmacokinetics, and intrathecal drug delivery. The search results were limited to the English language.ResultsOver 300 papers were identified. The literature was condensed and digested to evaluate the most commonly used medications in practice, sto serve as a foundation for review. We review on-label medications: ziconotide and morphine, and off label medications including fentanyl, sufentail, and hydromorphine.ConclusionIntrathecal therapy has level-one evidence for use for malignant pain and nonmalignant pain, with continued cost savings and improved safety. To most effectively serve our patients, a clear appreciation for the pharmacology of these commonly employed medication is paramount..

show abstract

“…It has been reported that equivalent pain control can be achieved with much lower intrathecal doses of hydromorphone than morphine (approximately 20% of morphine doses), with a lower potential for undesirable side effects. 32,33 Medication rotation and a polyanalgesic approach of adding a second or third medication before the concentration or daily dose of any one medication reaches the upper limit of recommendations may prove prudent in reducing the incidence of intrathecal mass propagation. The potential for significant neurologic compromise that may occur with an intrathecal catheter-tip inflammatory mass and the adverse consequences of self-extraction from an intrathecal pump necessitate aggressive assessment and management.…”

Section: Preventionmentioning

confidence: 99%

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

2011

View full text Add to dashboard Cite

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 ...

show abstract

Intrathecal Hydromorphone for Chronic Nonmalignant Pain: A Retrospective Study

Abstract: Hydromorphone can be a safe, analgesic alternative for long-term intrathecal management of nonmalignant pain among patients in whom morphine fails because of pharmacological side effects or inadequate pain relief.

Cited by 64 publications

References 61 publications

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain

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

Contact Info

Product

Resources

About