Intentional Intrathecal Opioid Detoxification in 3 Patients: Characterization of the Intrathecal Opioid Withdrawal Syndrome

Abstract

This preliminary work demonstrates the safety of abrupt IT opioid cessation utilizing standardized inpatient withdrawal protocols. To our knowledge, these are among the first reported cases of intentional, controlled IT opioid cessation without initiation of an opioid bridge: self-reported pain scores, functional capacity, and quality of life improved. The IT opioid withdrawal syndrome is characterized based upon our observations and a review of the literature.

Endothelin ETAreceptor antagonist reverses naloxone-precipitated opioid withdrawal in mice

“…Some of the adverse effects of opioid withdrawal include sedation, respiratory depression, cramps, changes in body temperature, diarrhea and emesis (Doyon 2004;Krantz and Mehler 2004;Rehni et al 2013;Schug et al 1992). A large number of patients undergoing opioid withdrawal also exhibit debilitating withdrawal symptoms such as tachycardia, cardiac arrhythmias, hypertension, anxiety, stroke and seizures (Himmelsbach 1937;Jackson et al 2013;Martin and Jasinski 1969).…”

The use of ketamine infusion to dramatically reduce opioid requirements in a patient whose high‐dose intrathecal opioid pump was inadvertently cut during surgery

“…Hence, it is possible that the extent of tolerance and withdrawal in our patient may not have significantly differed from a person on much lower oral or parenteral doses. Previous reports have described using symptom‐triggered clonidine and buprenorphine to abruptly wean patients from high‐dose intrathecal opioids in an inpatient setting, but these patients experienced some signs of withdrawal and were not subject to the acute barrage of nociceptive input and psychological stress that follows surgery 24 …”

“…Previous reports have described using symptom-triggered clonidine and buprenorphine to abruptly wean patients from high-dose intrathecal opioids in an inpatient setting, but these patients experienced some signs of withdrawal and were not subject to the acute barrage of nociceptive input and psychological stress that follows surgery. 24 Until recently, there has been limited guidance from professional societies on the therapeutic use of ketamine in chronic pain patients. In 2018, Regional Anesthesia & Pain Medicine published consensus guidelines on the use of ketamine infusions to treat chronic pain.…”

Advances in intrathecal drug delivery

“…Jackson et al [9] describe a safe procedure to abruptly discontinue intrathecal opioid therapy utilizing standardized inpatient withdrawal protocols, with no initiation of an opioid bridge, using buprenorphine and clonidine.…”