Intrathecal opioid treatment for chronic non-malignant pain: a 3-year prospective study

Abstract

Intrathecal (IT) opioid therapy is a treatment alternative for patients with severe chronic non-malignant pain. Several uncontrolled retrospective and prospective outcome studies have suggested a benefit in chronic non-malignant pain patients, but uncertainties about patient selection in these studies weaken the results. This study evaluated long-term outcome of IT opioid therapy in chronic non-malignant pain prospectively, and included two comparative groups to improve understanding of selection criteria and relative severity of intrathecal pump recipients (PRs). The study subjects included 38 PRs while the comparative groups included 31 intrathecal candidates who either had an unsuccessful trial, or declined the IT therapy, and another group of 41 newly referred patients. The following data were analyzed at study entry, and at 6 monthly intervals for a 3-year period: Symptom Check List 90 (SLC-90), SF-36 Health survey, Beck Depression Inventory, McGill Pain Questionnaire (short form), Oswestry Disability Index, Pain Drawings and Pain rating on visual analogue scale. Data analysis suggests the study group of PRs had improvements in pain, mood, and function from baseline to 36 months. These same parameters improved among new referrals (less severe patients receiving conservative pain management) while non-recipients significantly worsened. Although PRs improved, they were still worse off at 36 months than new referrals were at baseline. The study showed that when patients with extremely severe pain problems are selected as pump candidates, they will likely improve with the therapy, but their overall severity of pain and symptoms still remains high.

Chest Pain Syndromes

“…On a population basis, the relationship between alcohol intake and coronary mortality is a U or J shape. A recent long-term study of [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] year olds showed that the 6% who took up moderate alcohol were 38% less likely to develop CAD compared to their persistently nondrinking counterparts [34]. The consistent association between moderate alcohol intake (2 units a day for women and 3 units a day for men) and cardiovascular risk reduction is attributed to beneficial effects on HDL-cholesterol, fibrinogen and glucose intolerance [35].…”

“…Long-term outcomes are uncertain. A prospective case study followed 38 intrathecal pump recipients for 3 years after implantation and concluded that although intrathecal analgesic administration may improve pain, mood and function, this group of patients continue to experience severe symptoms [47]. Importantly, there is little evidence of overall benefit to chronic angina patients using intrathecal infusion pumps and worldwide experience is limited to a very small number of specialist units [48].…”

Spinal and epidural analgesia in the management of chronic pain

“…Et pourtant, ces techniques qui sont loin d'être récentes, font l'objet de très nombreuses publications et études scientifiques [16] dont les toutes dernières adoptent une méthodologie scientifique rigoureuse, reposent pour certaines séries sur des centaines de malades [23], bref tout est réuni pour pouvoir dégager une position et essayer autant que faire se peut, de se déconnecter de cette position de l'affectif qui encore une fois caractérise souvent le regard que nous portons sur ces techniques.…”

Cost Effectiveness of Intrathecal Drug Therapy in Management of Chronic Nonmalignant Pain

“…The benefits of IDT are manifested in improved pain control, functional capability, health-related quality of life, while containing the demand for health care resources. [6][7][8][9][10][11][12][13] IDT is a minimally invasive therapeutic technique that relies on implantation of a variety of drug delivery systems, with accessories using either programmable or nonprogrammable pumps. The system enables administration of analgesics directly into the intrathecal space.…”