Prospective Observational Study of Patient-Controlled Intrathecal Analgesia

Abstract

In patients with poorly controlled cancer pain, PCIA is associated with improved pain control, improved cancer-related symptoms, and high satisfaction. Compared with conventional BTP regimens, PCIA provides superior analgesia and a 3-fold faster onset of action.

Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

“…The authors also discussed IT dosing of medications and presented a method of titrating up IT drug while reducing systemic opioids (2). Brogan et al (2015) conducted a prospective study in 98 patients with refractory cancer pain implanted with an IT pump. The purpose of the study was to examine the effect of patient-controlled intrathecal analgesia (PCIA) on analgesic efficacy.…”

Intrathecal Therapy for Cancer-Related Pain

“…Development of the Personal Therapy Manager (PTM) for the SynchroMed® Infusion System (Medtronic, Minneapolis, MN) extended the availability of patient-controlled analgesia to IT medication delivery [ 86 , 87 ]. This technology allows patients the freedom (within physician-set limits) to self-administer boluses of pain medication either in place of a continuous infusion pump or in response to breakthrough pain during use of a continuous pump system [ 88 ]. Similar patient-controlled IT bolus dosing is available for the Prometra ® II Programmable Pump System (Flowonix Medical, Mt Olive, NJ) [ 89 ].…”

“…A recent prospective study that evaluated the use of PCA during IT therapy with a number of agents (i.e., morphine, hydromorphone, fentanyl, bupivacaine, clonidine, baclofen, and ziconotide) in the management of patients with refractory cancer-related pain further demonstrated beneficial effects of IT PCA therapy [ 88 ]. Most patients (91%) in the trial received either morphine or hydromorphone in their IT regimen; nine patients (16%) received ziconotide [ 88 ].…”

“…A recent prospective study that evaluated the use of PCA during IT therapy with a number of agents (i.e., morphine, hydromorphone, fentanyl, bupivacaine, clonidine, baclofen, and ziconotide) in the management of patients with refractory cancer-related pain further demonstrated beneficial effects of IT PCA therapy [ 88 ]. Most patients (91%) in the trial received either morphine or hydromorphone in their IT regimen; nine patients (16%) received ziconotide [ 88 ]. In the 58 patients with available follow-up data, numerical rating scale score for “worst” pain decreased from 8.3 (out of 10) at baseline to 5.0 with IT therapy (average duration of follow-up, 42 days); 56% of patients obtained ≥30% pain reduction and 44% of patients obtained ≥50% pain reduction; the proportion of patients with severe pain (NRS score ≥7) decreased from 84% to 35% [ 88 ].…”

Initiation of Intrathecal Drug Delivery Dramatically Reduces Systemic Opioid Use in Patients With Advanced Cancer

“…Intrathecal drug delivery (IDD), also referred to as targeted drug delivery (TDD) or intrathecal therapy (ITT), has long been used for patients with inadequate pain control despite systemic opioid escalation or dose-limiting opioid-related side effects. IDD has been shown to improve analgesia, reduce medical costs, decrease hospital visits, reduce opioid-related side effects, decrease opioid consumption, effectively manage breakthrough pain, reduce serum opioid levels, and preserve quality of life in patients with severe cancer-related pain (6)(7)(8)(9)(10)(11)(12)(13). IDDS implantation carries risks, including infection, bleeding, neurologic injury, cerebrospinal fluid leak, and postdural puncture headache.…”