Total pancreatectomy with islet cell transplantation<i>vs</i>intrathecal narcotic pump infusion for pain control in chronic pancreatitis

Mokadem, Mohamad; Noureddine, Lama; Howard, Thomas J.; McHenry, Lee; Sherman, Stuart; Fogel, Evan L.; Watkins, James L.; Lehman, Glen A.

doi:10.3748/wjg.v22.i16.4160

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…ITP therapy for patients with severe, intractable chronic pain related to chronic pancreatitis has been previously studied. We found similar results in our study as compared with previous studies demonstrating ITP as an alternative treatment modality to both narcotics and surgical intervention (13)(14)(15). One recent study comparing ITP therapy with total pancreatectomy and islet cell transplant showed that in addition to achieving similar levels of pain control, compared with patients undergoing total pancreatectomy for chronic pancreatitis, there was a further benefit of preserved glucose and insulin metabolism in the patients who underwent ITP therapy (13).…”

Section: Discussionsupporting

confidence: 91%

Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Tiwari¹

2017

PMCR

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Background: This retrospective study analyzed data among a single-center cohort of patients at a university hospital center designed as an Institutional Review Board (IRB)-approved retrospective chart review to assess the outcomes associated with intrathecal pump (ITP) placement in patients with severe abdominal pain from chronic pancreatitis. Objectives: Examine ITP therapy as an alternative form of analgesia for chronic pancreatitis. Study Design: A retrospective analysis. Setting: The pain management department at the University of Toledo. Methods: The primary outcomes assessed oral narcotic requirement, visual analog scale (VAS) pain scores, and the number of hospital admissions, with the outcome assessments taken pre-ITP placement and 1, 6, 12, and 24 months post-ITP placement. Results: A total of 8 patients, with a mean age of 44.6 years, who underwent ITP placement following failed conservative therapies for abdominal pain from chronic pancreatitis were reviewed. A reduction in pain level average (VAS) was noted from pre-ITP placement (VAS = 8.38, SD = 1.49) to post-ITP placement at 1 month (VAS = 4.85, SD = 2.20, P = 0.0127), 6 months (VAS = 4.43, SD = 2.50, P = 0.0134), 12 months (VAS = 3.67, SD = 2.36, P = 0.0112), and 24 months (VAS = 4.8, SD = 2.63, P = 0.0459). A reduction in mean hospitalizations (MH) post-ITP was noted from pre-ITP placement (MH = 9.25, SD = 11.12) to post-placement at 1 month (MH = 0, SD = 0, P = 0.0637), 6 months (MH = 0.125, SD = 0.33, P = 0.1403), 12 months (MH = 0.167, SD = 0.37, P = 0.1502), and 24 months (MH = 0.2, SD = 0.4, P = 0.1457). A reduction in mean oral morphine sulfate equivalents (MEq) occurred from pre-ITP placement (MEq = 293.98, SD = 302.99) to post- ITP placement at 1 month (MEq = 11.025, SD = 19.35, P = 0.0369), 6 months (MEq = 14.4, SD = 19.55, P = 0.0578), 12 months (MEq = 19.95, SD = 24.24, P = 0.0542), and 24 months (MEq = 17.64, SD = 29.38, P = 0.0896). Limitations: The small sample size and the retrospective nature of this study prove to be 2 major limitations. Conclusions: Statistically significant improvements in postoperative pain levels across all of the time intervals post-ITP, in addition to large gross reductions in MH and MEq, collectively yield promising results for ITP therapy as an alternative treatment modality for chronic abdominal pain in patients with chronic pancreatitis. Key words: Intrathecal pump, intrathecal therapy, chronic pancreatitis, abdominal pain, chronic pain, analgesic effectiveness

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Section: Discussionsupporting

confidence: 91%

Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Tiwari¹

2017

PMCR

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“…Relieving pain and reducing narcotic use is the primary objective of TPIAT[ 49 ]. In our meta-analysis, narcotic independence was achieved in 53.5% of adults post-TPIAT and 51.9% of children post-TPIAT[ 15 - 17 , 25 , 29 , 30 , 32 - 35 , 37 , 39 , 43 , 44 , 50 - 52 ].…”

Section: Discussionmentioning

confidence: 95%

Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

Khazaaleh¹,

Babar²,

Alomari³

et al. 2023

World J Transplant

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BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited. AIM To evaluate the outcomes of TPIAT. METHODS We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I 2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger’s test. RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, P < 0.05, I 2 = 81%] of adults compared to 51.9% (95%CI: 17-85, P < 0.05, I 2 = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, P < 0.05, I 2 = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, P < 0.05, I 2 = 82%) in children. Glycated hemoglobin (HbA 1C ) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% ( P = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies. CONCLUSION These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.

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“…Multimodal treatment strategies include medications, endoscopic intervention, and, in intractable cases, surgical intervention. Total pancreatectomy with islet cell transplantation offers a definitive treatment of abdominal pain but carries with it an increased risk of mortality and increased risk of insulin dependence [ 5 ]. Targeted drug delivery (TDD) is a relatively new alternative therapy in CP patients.…”

Section: Introductionmentioning

confidence: 99%

“…A case series demonstrated in 2009 that TDD led to a significant decrease in pain with a morphine-equivalent dosage less than that required before pump placement. More recently, in 2016, Mokadem et al published a case-control study that compared treatment with TDD to total pancreatectomy with islet cell transplant (TP + ICT), which demonstrated comparable pain control between the two groups with a significantly decreased risk of insulin dependence in the TDD group [ 5 ]. We aimed to perform an institutional retrospective review of CP patients treated with TDD versus oral analgesia to evaluate long-term pain control.…”

Section: Introductionmentioning

confidence: 99%

Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series

Cooper,

Progar,

Grott

et al. 2024

Cureus

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Summary: Abdominal pain secondary to chronic pancreatitis (CP) is difficult to manage and often requires chronic oral opioid therapy (OOT). Targeted drug delivery (TDD) allows for a diminished dose of opioid intake and improved pain levels. TDD has been used in different pain syndromes with only limited reports in CP. Objective: The objective of this article is to perform a retrospective review of CP patients treated with TDD versus OOT to compare chronic pain control and consumed morphine-equivalent doses. Methods: Patients receiving TDD between September 2011 and August 2018 were included. All patients were weaned off oral opioids one week before intrathecal trial and pump implantation. Patients with intrathecal trials providing at least 50% pain relief underwent pump implantation. Data were collected while on OOT and at two weeks, three months, and nine months post-implant. Data were analyzed with Microsoft Excel 365 MSO using means and standard deviations. P-values were calculated using a two-tailed student’s t-test with paired two-sample means. Results: Twenty-three patients were analyzed. Pre-trial average pain score was 6.5/10 with a mean improvement with trials greater than 71%. The mean chronic baseline oral morphine milligram equivalents (MME) was 188. The mean MME on TDD at two weeks (0.36), three months (1.39), and nine months (2.47) were significantly lower than OOT. Mean pain scores were 6, 4.9, and 5.6 at two weeks, three months, and nine months, respectively, compared to 6.5 on OOT. Discussion: The results of this study indicate that TDD provides improved pain control with significantly lower opioid doses.

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Total pancreatectomy with islet cell transplantationvsintrathecal narcotic pump infusion for pain control in chronic pancreatitis

Cited by 8 publications

References 22 publications

Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series

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