Predictive Value of Intrathecal Narcotic Trials for Long‐Term Therapy with Implantable Drug Administration Systems in Chronic Non‐Cancer Pain Patients

Abstract

This study retrospectively investigated the predictive value of intrathecal narcotic trials for long-term drug utilization via implantable pumps in chronic non-cancer patients. Data were derived from 86 patients who were categorized according to the intrathecal narcotic dose that resulted in the optimal trial response. The response during the trial period and the pattern of long-term utilization of morphine was studied, as was the impact of age, gender and diagnosis. The analysis revealed that low dose responders had lower daily dose requirements at 18 months than standard dose and high dose responders. It also showed that women had lower total daily dose requirements at 18 and 24 months and that individuals over 65 years of age had lower total daily dose requirements at 18 months. A trend toward a disproportionately higher use of adjuvant drugs and narcotic substitutions was found among high dose responders, while a trend toward a disproportionately higher total daily dose was found among cervicalgia patients. The findings indicate that the responsiveness to an intrathecal narcotic during a trial, along with the diagnosis at the time of implantation, and the patient's age and gender can shed light on the long-term utilization of intrathecal analgesics in chronic non-cancer patients. This information may be used to better select patients and design trials that more closely reflect long-term drug utilization.

Intrathecal Trialing of Continuous Infusion Combination Therapy With Hydromorphone and Bupivacaine in Failed Back Surgery Patients

“…The predictive value of the IT trial on the course of therapy following IDDS implant is not entirely clear, although several conclusions can be made. In concordance with the study by Dominguez et al patients who required higher hydromorphone doses during the trial period to achieve adequate pain relief had a positive correlation with higher hydromorphone doses at implant, 12 months, and 24 months as well as higher rates of opioid dose escalation at 12 and 24 months. Similar findings were noted with pre‐trial MEDD.…”

The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines

“…Many authors recommend weaning strategies , with the core concept of improving patient selection by moving away from salvaging high‐dose systemic opioid failure. The predictive value of systemic dose requirement to IT opioid dose requirement is somewhat obscured with the recently described weaning strategies, but the theme is suggested .…”

Role of Pretrial Systemic Opioid Requirements, Intrathecal Trial Dose, and Non-psychological Factors as Predictors of Outcome for Intrathecal Pump Therapy: One Clinician’s Experience with Lumbar Postlaminectomy Pain

“…Dominguez et al. retrospectively divided their pump patients into high dose trial group (1 mg morphine), standard dose trial group (0.5 mg), and low dose trial group (0.25 mg) (23). They reported higher rates of opioid dose escalation in the high dose trial group.…”