Clinical realities and economic considerations: Patient selection in intrathecal therapy

Krames, Elliot S.; Olson, Kern A.

doi:10.1016/s0885-3924(97)00166-8

Cited by 73 publications

(70 citation statements)

References 21 publications

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“…Analgesic drugs, such as opioids, administrated intrathecally with an implantable infusion pump produce a potent analgesic effect via central nervous system opioid receptors and their use is increasing [4][5][6][7][8][9].…”

mentioning

confidence: 99%

Stability and compatibility of drug mixtures in an implantable infusion system

Bianchi¹,

Ginggen²,

Tardy³

2008

Anaesthesia

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SummaryThis study evaluated the stability and the compatibility of mixtures of morphine sulphate, bupivacaine, and clonidine hydrochloride and of hydromorphone, bupivacaine, and clonidine hydrochloride, when used in constant flow implantable pumps under simulated clinical use conditions. The pumps were filled with drug mixtures and incubated at 37°C for a period of 90 days. Aliquots were sampled monthly from the reservoir and catheter outlet and the drug concentrations analysed using validated chromatography methods. Individual materials from the infusion system were immersed in the drug mixtures and stored at 37°C for 60 weeks and evaluated for mechanical performance for compatibility testing. Both drug mixtures were found to be stable over 90 days in the pump at 37°C. All device materials retained acceptable mechanical performance following exposure. These results demonstrate that both drug mixtures are stable when maintained at simulated body temperature in an implantable infusion system for 90 days.

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mentioning

confidence: 99%

Stability and compatibility of drug mixtures in an implantable infusion system

Bianchi¹,

Ginggen²,

Tardy³

2008

Anaesthesia

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“…18,24 Evaluation of patients with chronic nonmalignant pain must incorporate a complete psychological and neurologic examination before intrathecal pump implantation. 23 Patients selected for longterm intrathecal therapy must have a favorable psychosocial evaluation and a positive response to a screening trial.…”

Section: 24 Commonmentioning

confidence: 99%

“…25,26 Psychological risk factors for poor outcome include major psychopathology, mood disorders, potential for self-harm, dementia from highdose opioids, high levels of distress, and functional pain syndromes. 23,24 Untreated drug addiction is a contraindication to implanted intrathecal therapy. 18,23,24 Delivery system selection.…”

Section: 24 Commonmentioning

confidence: 99%

Intrathecal drug therapy for long-term pain management

Ghafoor

Epshteyn²,

Carlson

et al. 2007

American Journal of Health-System Pharmacy

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The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.

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“…Cette problématique rappelle 48 l'absolue nécessité de réaliser des évaluations régulières et à longs termes. Cette nécessité est particulièrement importante dans le cadre de la prise en charge de douleur non cancéreuse [14,17].…”

Section: Les Contre-indicationsunclassified

Spinal and epidural analgesia in the management of chronic pain

Meignier¹,

Verleysen-Robin²

2007

Douleur analg.

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La place des techniques d'analgésie périmédullaire dépend grandement de l'expérience des équipes, mais cette méthode analgésique reste globalement insuffisamment pratiquée en France au regard de l'expérience étrangère ; pourtant un choix, voire une sélection rigoureuse des patients, une sélection des produits et des techniques permettent une prise en compte adéquate de nombreuses situations extrêmes tant en douleur cancéreuse que bénigne ; les risques sont connus, identifiés et en large partie prévisibles ; le problème reste toujours celui de l'expérience humaine, de la lourdeur de l'investissement par l'équipe de prise en charge et de difficultés administratives certaines.Abstract: The importance of invasive methods in the treatment of chronic and recurrent debilitating pain remains controversial. Epidural and inthrathecal techniques are offering viable options by providing patients with relief, particularly in the case of pain with multiple manifestations and causal mechanisms, whether resulting from cancers or non-malignant tumours. However, these techniques also require experience and expertise to be safe. They are associated with some risk, which must be assessed and might have economic ramifications. Therefore, it is clear that the decision to use these methods must be based on a rigorous protocol for selecting patients and deciding appropriate analgesics; this requires a truly multidisciplinary medical team. For this reason, these techniques are part of a vast therapeutic reserve we rely on conservatively. They do not offer the best solution, but they can and should contribute to relieving pain in many of these patients.

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Clinical realities and economic considerations: Patient selection in intrathecal therapy

Cited by 73 publications

References 21 publications

Stability and compatibility of drug mixtures in an implantable infusion system

Stability and compatibility of drug mixtures in an implantable infusion system

Intrathecal drug therapy for long-term pain management

Spinal and epidural analgesia in the management of chronic pain

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