Successful Discontinuation of Systemic Opioids After Implantation of an Intrathecal Drug Delivery System

The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy

“…This study suggested that patients with mechanical or nociceptive low back pain were more responsive than patients with pure neuropathic pain syndromes to low‐dose IT opioids . Again, similar to studies by Hamza et al and Caraway et al, sustained analgesia was seen at IT doses significantly lower than previously reported in the literature .…”

“…While the original approach of IT, low‐dose, opioid therapy recommended pretrial opioid elimination, the recommendation was not based on strong clinical or experimental evidence. The works of Hamza et al, Hatheway et al, and Caraway et al strongly suggest that similar analgesic results can be obtained with opioid elimination occurring during or shortly after trial . Pretrial opioid taper may be beneficial for those subjects who are opioid tolerant or have opioid‐induced hyperalgesia, or for those who may be at higher risk of opioid‐induced respiratory depression in the hours or days after implantation of an IDDS.…”

Efficacy of a Targeted Drug Delivery on‐Demand Bolus Option for Chronic Pain

“…Caraway et al retrospectively analyzed 99 consecutive patients with TDD in a population that consisted of patients with “back and limb pain who were taking systemic opioids.” Diagnoses in this subset were not further classified, and patients with and without an intrathecal bolus device were considered collectively, though those with access to a bolus device were described as “a minority.” One hundred percent of patients eliminated systemic extended‐release opioids within 1 month of TDD implantation. At 1‐month, 1‐year, and 5‐year time points, 68%, 84%, and 92% of patients, respectively, eliminated systemic oral short‐acting breakthrough opioids.…”

“…Maintaining both oral and intrathecal analgesics exposes patients to risks attributable to both routes of therapy, increases total analgesic costs, and decreases patient convenience. Exclusively utilizing TDD to treat both breakthrough and incident pain may represent an avenue to improve patient satisfaction and safety . We believe that a bolus option has additional opportunity to further fill a void in managing unpredictable breakthrough pain in patients with a TDD system, potentially eliminating the need for oral short‐acting breakthrough opioids entirely in this patient population.…”

Intrathecal Analgesic Drug Delivery is Effective for Analgesia in a Patient with Post-Poliomyelitis Syndrome: A Case Report

“…A variety of medications have been used with varying success. In the case of severe, refractory pain, placement of an intrathecal drug delivery system (ITDD) may provide an alternate route of delivery compared with systemic opioids with their associated side effects [12–14]; ITDD may offer a way to achieve significant and lasting pain relief with the fewest possible side effects [15,16]. …”