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By Xander Zuidema MD, pharmD, Anesthesiologist, intensivist, pain specialist
Peter E Konrad, John M Huffman, Lisa M Stearns, Robert J Plunkett, Eric J Grigsby, E K Stromberg, Mollie P Roediger, Michelle D Wells, Todd W Weaver
OBJECTIVES: The ISPR was initially created to monitor the product performance of Medtronic implanted intrathecal drug infusion and spinal cord systems available in the United States. MATERIALS AND METHODS: Data were collected from 50 representative sites implanting and following patients with intrathecal drug delivery systems across the United States between August 7, 2003 and January 31, 2014. Device performance over time was estimated using life table survival methods...
October 12, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Sam Eldabe, Rui V Duarte, Grace Madzinga, Alan M Batterham, Morag E Brookes, Ashish P Gulve, Christophe Perruchoud, Jon H Raphael, David Lorenzana, Eric Buchser
OBJECTIVE:  Intrathecal drug delivery (ITDD) is commonly used for intractable pain management. A paucity of good-quality studies in chronic noncancer patients and concerns over increased dosages have focused interest on different modes of administration. The aim of this international multicenter randomized double-blind crossover trial was to compare the efficacy of the same daily dose of drugs administered by intermittent boluses vs simple continuous infusion. METHODS:  Eligible patients implanted with a programmable ITDD device were randomized to receive two weeks of either intermittent boluses or a simple continuous flow in period 1, followed by a crossover to the alternative mode of administration...
September 19, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Maura M Scanlon, Halena M Gazelka, Susan M Moeschler, Bryan C Hoelzer, W Michael Hooten, Markus A Bendel, Tim J Lamer
OBJECTIVES:  Our purpose was to determine the incidence of surgical site infection (SSI) in cancer patients receiving an intrathecal drug delivery system (IDDS) and compare that rate with the incidence of SSI in the general population receiving an IDDS or spinal cord stimulator. We attempted to describe risk factors for SSIs in cancer patients treated with IDDS in terms of exposure to cancer treatments. DESIGN:  Retrospective review. SETTING:  Large tertiary care center...
August 22, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Julia Prusik, Charles Argoff, Sophia Peng, Julie G Pilitsis
BACKGROUND: Ziconotide use in intrathecal drug therapy (IDT) has been limited by dosing related side effects. We examine our experience with ziconotide as a first line IDT monotherapy in patients with chronic pain and present our low and slow dosing algorithm aimed at reducing these patient experienced side effects while adequately managing pain. METHODS: We retrospectively reviewed demographics, dosing, and outcomes of 15 consecutive patients with complete three-month data sets implanted with intrathecal pain pumps more than three years utilizing ziconotide as a first-line monotherapy...
August 5, 2016: Neuromodulation: Journal of the International Neuromodulation Society
I Elias Veizi, Salim M Hayek, Michael Hanes, Ryan Galica, Sivakanth Katta, Tony Yaksh
BACKGROUND: Intrathecal drug delivery therapy has been used effectively in treating patients with intractable chronic pain. The development of an intrathecal catheter tip granuloma (ICTG) related to delivery of intrathecal opiates is a relatively infrequent, but potentially devastating complication. While there are many morphine-related ICTG cases described, reports of hydromorphone-related ICTG are limited. In addition, studies suggest a strong correlation between the use of higher doses and concentrations of intrathecal opiates and ICTG formation...
October 2016: Neuromodulation: Journal of the International Neuromodulation Society
Sanjeet Narang, Suresh K Srinivasan, Nantthasorn Zinboonyahgoon, Christian E Sampson
INTRODUCTION: Neuraxial drug delivery via intrathecal drug delivery systems (IDDS) is becoming an increasingly common mode of treating intractable cancer-related pain, chronic pain, or severe spasticity. An implanted infusion pump delivers medication into the intrathecal (subarachnoid) space via a thin catheter. These pumps are commonly placed in the anterior abdominal wall. Certain conditions may render it difficult or unsafe for an IDDS to be implanted at the traditional site; thus, alternative sites have been explored...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
Kelly A Eddinger, Eric S Rondon, Veronica I Shubayev, Marjorie R Grafe, Miriam Scadeng, Keith R Hildebrand, Linda M Page, Shelle A Malkmus, Joanne J Steinauer, Tony L Yaksh
BACKGROUND: Intrathecal infusion of opioids in dogs, sheep, and humans produces local space-occupying masses. To develop a small-animal model, the authors examined effects of intrathecal catheterization and morphine infusion in guinea pigs. METHODS: Under isoflurane, polyethylene or polyurethane catheters were advanced from the cisterna magna to the lumbar enlargement. Drugs were delivered as a bolus through the externalized catheter or continuously by subcutaneous minipumps...
August 2016: Anesthesiology
Brian M Bruel, Allen W Burton
OBJECTIVE: The increasing incidence of cancer survivorship has shifted treatment of cancer-related pain from short-term analgesia to long-term chronic pain management. As a result, alternatives to oral analgesics, such as intrathecal therapy, may be beneficial for patients with cancer-related pain. The authors review the use of intrathecal therapy in the management of cancer-related pain. METHODS: The Medline database was searched for English-language articles that included "ziconotide" or "morphine" AND ("cancer" OR "malignant") AND "intrathecal" in title or abstract...
April 28, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Fumiko Sekiguchi, Yuma Kawara, Maho Tsubota, Eri Kawakami, Tomoka Ozaki, Yudai Kawaishi, Shiori Tomita, Daiki Kanaoka, Shigeru Yoshida, Tsuyako Ohkubo, Atsufumi Kawabata
T-type Ca channels (T channels), particularly Cav3.2 among the 3 isoforms, play a role in neuropathic and visceral pain. We thus characterized the effects of RQ-00311651 (RQ), a novel T-channel blocker, in HEK293 cells transfected with human Cav3.1 or Cav3.2 by electrophysiological and fluorescent Ca signaling assays, and also evaluated the antiallodynic/antihyperalgesic activity of RQ in somatic, visceral, and neuropathic pain models in rodents. RQ-00311651 strongly suppressed T currents when tested at holding potentials of -65 ∼ -60 mV, but not -80 mV, in the Cav3...
August 2016: Pain
Hans P Sviggum, Katherine W Arendt, Adam K Jacob, Adam D Niesen, Rebecca L Johnson, Darrell R Schroeder, Michael Tien, Carlos B Mantilla
BACKGROUND: Intrathecal (IT) morphine is considered the "gold standard" for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 μg. There is less experience with IT hydromorphone for postcesarean analgesia and limited information on its optimal analgesic dose. We conducted this study to determine the effective analgesic dose for 90% patients (ED90) of IT hydromorphone that provides effective analgesia for women undergoing elective cesarean delivery and its potency ratio to IT morphine...
September 2016: Anesthesia and Analgesia
Hadas Nahman-Averbuch, Lior Dayan, Elliot Sprecher, Uri Hochberg, Silviu Brill, David Yarnitsky, Giris Jacob
OBJECTIVE: . The α2-agonist clonidine is an analgesic agent, whose yet uncertain action may involve either increase in pain modulation efficiency, change in autonomic function, and/or decrease in anxiety level. The present study aimed to examine the effect of oral clonidine on pain perception in healthy subjects in order to reveal its mode of action. DESIGN: . Randomized, double-blind, placebo-controlled study. SUBJECTS: . Forty healthy subjects...
February 18, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Tim Reck, En-Chul Chang, Markus Béchir, Ulrich Kallenbach
OBJECTIVES: The speed of intrathecal drug administration (slow continuous infusion vs. rapid bolus application) might influence the efficacy of therapy despite the equal daily dose in both administration patterns. We tested this hypothesis in a small prospective single-centre pilot study in a population of chronic pain patients with intrathecal opioid therapy. METHODS: Ten patients receiving intrathecal opioids for chronic pain assessed their pain four times daily on a numeric rating scale (NRS), more than the time course of six weeks divided into three blocks of two weeks each: Baseline evaluation (intrathecal pumps with previously established continuous infusion settings), followed by two blinded trial blocks of continuous (same pump parameters as during evaluation) and bolus (40% of daily dose split into four equal boli applied every six hours, with the remaining 60% as background continuous infusion) regimes...
July 2016: Neuromodulation: Journal of the International Neuromodulation Society
Gladstone C McDowell, Jason E Pope
INTRODUCTION: Ziconotide is a non-opioid analgesic for intrathecal (IT) administration. The aim of this review is to provide a comprehensive and clinically relevant summary of the literature on dosing and administration with IT ziconotide in the management of refractory chronic pain, and to describe novel dosing strategies intended to improve clinical outcomes. MATERIALS AND METHODS: A Medline search was conducted for "ziconotide," supplemented by manual searching of published bibliographies and abstracts from conferences...
July 2016: Neuromodulation: Journal of the International Neuromodulation Society
Marta Imamura, Satiko Tomikawa Imamura, Rosa Alves Targino, León Morales-Quezada, Luis C Onoda Tomikawa, Luis G Onoda Tomikawa, Fabio M Alfieri, Thais R Filippo, Ivan D da Rocha, Raul Bolliger Neto, Felipe Fregni, Linamara Rizzo Battistella
UNLABELLED: In this large, sham-controlled, randomized trial, we examined the efficacy of the combination of standard treatment and paraspinous lidocaine injection compared with standard therapy alone in subjects with chronic low back pain. There is little research-based evidence for the routine clinical use of paraspinous lidocaine injection for low back pain. A total of 378 subjects with nonspecific chronic low back pain were randomized to 3 groups: paraspinous lidocaine injection, analgesics, and exercises (group 1, LID-INJ); sham paraspinous lidocaine injection, analgesics, and exercises (group 2, SH-INJ); and analgesics and exercises (group 3, STD-TTR)...
May 2016: Journal of Pain: Official Journal of the American Pain Society
Sadegh Abdolmohammadi, Pierre-Olivier Hétu, Andrée Néron, Gilbert Blaise
The aim of the present study was to explore the effectiveness of an alternative method to manage pain based on a time-limited intrathecal (IT) infusion of an analgesic medication mixture. Three patients (69, 64 and 94 years of age) with intractable and poorly controlled pain due to bed sores, pelvic metastatic mass, and thoracic vertebra and rib fractures, respectively, were treated. Daily doses of opioids could not be increased due to side effects. An IT catheter (20 G) was placed by percutaneous approach in the lumbar area while advancing toward the thoracic region, and was then tunnelled and fixed subcutaneously...
May 2015: Pain Research & Management: the Journal of the Canadian Pain Society
Mary B Roberts, Peter D Drummond
INTRODUCTION: Pain, mood problems, and sleeping difficulties are often comorbid and contribute to reduced physical function and quality of life for those with chronic pain. However, the way in which these factors interact is unclear. Until recently it was thought that the effect of sleep on pain and physical function was simply a result of its common association with mood problems. However, a growing body of research suggests that sleep may have a unique contribution. OBJECTIVES: The aim of this study was to determine whether sleep disturbances were associated with pain and poor physical function independent of psychological distress in patients attending a tertiary pain medicine unit...
September 2016: Clinical Journal of Pain
Jay S Grider, Mark A Etscheidt, Michael E Harned, Jason Lee, Ben Smith, Christina Lamar, Anjum Bux
OBJECTIVE: To evaluate low-dose intrathecal opioid trialing and maintenance with regard to analgesia and psychometric functional capacity. MATERIALS AND METHODS: Prospective cohort of subjects offered, trialed and maintained using low-dose opioid therapy via an intrathecal drug delivery system. Analgesia, measured by visual analog scale and the Global Pain Scale, and function, measured by Multidimensional Pain Inventory and Global Pain Scale, are evaluated. Population analysis by age, gender, oral opioid dose, diagnosis, and pain type is reported...
February 2016: Neuromodulation: Journal of the International Neuromodulation Society
Maged Hamza, Daniel M Doleys, Islam A Saleh, Andrew Medvedovsky, Michael H Verdolin, Monalyce Hamza
OBJECTIVE: The study aims to compare intrathecal (IT) boluses to continuous infusion trialing techniques prior to implantation of drug delivery systems (DDS) for the treatment of severe intractable chronic nonmalignant pain. DESIGN: This is a prospective, randomized, head-to-head long-term outcome study. MATERIALS AND METHODS: Forty patients with comparable patient demographics were randomly assigned to two cohorts. Cohort A trialed with intermittent boluses; Cohort B trialed with continuous infusion...
October 2015: Neuromodulation: Journal of the International Neuromodulation Society
Furio Zucco, Roberta Ciampichini, Angelo Lavano, Amedeo Costantini, Marisa De Rose, Paolo Poli, Gianpaolo Fortini, Laura Demartini, Enrico De Simone, Valentino Menardo, Piero Cisotto, Mario Meglio, Luciana Scalone, Lorenzo G Mantovani
OBJECTIVE: To assess the cost-effectiveness and cost-utility of Spinal Cord Stimulation (SCS) in patients with failed back surgery syndrome (FBSS) refractory to conventional medical management (CMM). MATERIALS AND METHODS: We conducted an observational, multicenter, longitudinal ambispective study, where patients with predominant leg pain refractory to CMM expecting to receive SCS+CMM were recruited in 9 Italian centers and followed up to 24 months after SCS. We collected data on clinical status (pain intensity, disability), Health-Related Quality-of-Life (HRQoL) and on direct and indirect costs before (pre-SCS) and after (post-SCS) the SCS intervention...
June 2015: Neuromodulation: Journal of the International Neuromodulation Society
Emmanuel Bäckryd, Jan Sörensen, Björn Gerdle
OBJECTIVES: The aim of this open-label, non-randomized, clinical trial was to evaluate the feasibility of trialing ziconotide by intrathecal bolus injections. MATERIAL AND METHODS: Twenty-three patients, who had peripheral neuropathic pain refractory to pharmacological treatment and were under consideration for Spinal Cord Stimulation, received up to three ziconotide bolus injections according to a comprehensive algorithm. After a first injection of 2.5 μg, the patients progressed in the algorithm depending on the presence or absence of pain reduction and significant adverse events...
July 2015: Neuromodulation: Journal of the International Neuromodulation Society
2015-04-18 19:48:48
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