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Patient Selection

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Abstract

Intrathecal therapy (IT) is used to treat a wide array of pain etiologies including nociceptive, neuropathic, or mixed, for both cancer-related and noncancer-related pain. IT is often considered when SCS fails and is an appropriate alternative to SCS in select patients with non-neuropathic pain or diffuse cancer pain. Common disease states and diagnoses for which IT has been successful in treating include diabetic neuropathy, radicular pain from failed back surgery syndrome, or severe rheumatoid or osteoarthritis pain throughout the body. Noncancer pain patients who need around-the-clock dosing of oral opioids or have failed oral opioid therapy due to intolerable side effects such as pruritus, constipation, or urinary retention are also excellent candidates for IT. Cancer patients with a life expectancy ≥3 months and cerebrospinal fluid (CSF) circulation which is not hampered by tumor burden are the patients most likely to benefit from this modality. Assessment of the patient when considering IT should include a complete physical, neurologic, radiologic, psychological, and social evaluation. In this chapter we will review the state of the literature concerning patient selection based on these assessments.

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Recommended Reading

  1. Bernards CM. Cerebrospinal fluid and spinal cord distribution of baclofen and bupivacaine during slow intrathecal infusion in pigs. Anesthesiology. 2006;105(1):169–78.

    Article  PubMed  Google Scholar 

  2. Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Med. 2009;10(4):639–53.

    Article  PubMed  Google Scholar 

  3. Chaney MA. Intrathecal and epidural anesthesia and analgesia for cardiac surgery. Anesth Analg. 2006;102(1):45–64.

    Article  CAS  PubMed  Google Scholar 

  4. Chou R, Turner JA, Devine EB, et al. The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for National Institutes of Health Pathways to Prevention Workshop Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain. Ann Intern Med. 2015;162(4):276–86.

    Article  PubMed  Google Scholar 

  5. Coffey RJ, Owens ML, Broste SK, et al. Medical practice perspective: identification and mitigation of risk factors for mortality associated with intrathecal opioids for non-cancer pain. Pain Med. 2010;11(7):1001–9.

    Article  PubMed  Google Scholar 

  6. Czernicki M, Sinovich G, Mihaylov I, et al. Intrathecal drug delivery for chronic pain management-scope, limitations and future. J Clin Monit Comput. 2015;29(2):241–9.

    Article  CAS  PubMed  Google Scholar 

  7. Deer TR, Pope JE. Factors to consider in the choice of intrathecal drug in the treatment of neuropathic pain. Expert Rev Clin Pharmacol. 2015;8(5):507–10.

    Article  CAS  PubMed  Google Scholar 

  8. Deer T, Krames ES, Hassenbusch S, et al. Future directions for intrathecal pain management: a review and update from the interdisciplinary polyanalgesic consensus conference 2007. Neuromodulation. 2008;11(2):92–7.

    Article  PubMed  Google Scholar 

  9. Deer T, Ranson M, Stewart D. Relevant anatomy for spinal delivery. Neuromodulation. New York: Elsevier; 2009a.

    Google Scholar 

  10. Deer TR, Krames E, Levy RM, Hassenbusch SJ 3rd, Prager JP. Practice choices and challenges in the current intrathecal therapy environment: an online survey. Pain Med. 2009b;10(2):304–9.

    Article  PubMed  Google Scholar 

  11. Deer TR, Smith HS, Burton AW, et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician. 2011;14(3):E283–312.

    PubMed  Google Scholar 

  12. Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference--2012: recommendations on trialing for intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15(5):420–35; discussion 435.

    Article  PubMed  Google Scholar 

  13. Deer TR, Pope JE, Hayek SM, et al. The polyanalgesic consensus conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation. 2017;20(2):96–132.

    Article  PubMed  Google Scholar 

  14. Department of Health and Human Services US. Centers for Disease Control and Prevention National diabetes fact sheet. at: www.cdc.gov/diabetes/pubs/ …. 2002.

  15. DiPaola CP, Saravanja DD, Boriani L, Zhang H. Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and …. Spine J. 2012. http://www.sciencedirect.com/science/article/pii/S1529943012000939.

  16. Doleys DM, Brown J. MMPI profile as an outcome “predictor” in the treatment of noncancer pain patients utilizing intraspinal opioid therapy. Neuromodulation. 2001;4(3):93–7.

    Article  CAS  PubMed  Google Scholar 

  17. Epstein NE. Preoperative, intraoperative, and postoperative measures to further reduce spinal infections. Surg Neurol Int. 2011;2:17.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Farney RJ, Walker JM, Cloward TV, Rhondeau S. Sleep-disordered breathing associated with long-term opioid therapy. Chest. 2003;123(2):632–9.

    Article  PubMed  Google Scholar 

  19. Fitzgibbon DR, Rathmell JP, Michna E, Stephens LS, Posner KL, Domino KB. Malpractice claims associated with medication management for chronic pain. Anesthesiology. 2010;112(4):948–56.

    Article  PubMed  Google Scholar 

  20. Flack SH, Bernards CM. Cerebrospinal fluid and spinal cord distribution of hyperbaric bupivacaine and baclofen during slow intrathecal infusion in pigs. Anesthesiology. 2010;112(1):165–73.

    Article  CAS  PubMed  Google Scholar 

  21. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol. 2015;22(1):162–215.

    Article  PubMed  Google Scholar 

  22. Follett KA, Burchiel K, Deer T, DuPen S. Prevention of intrathecal drug delivery catheter-related complications. Technology at the …. 2003. http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1403.2003.03005.x/full.

  23. Follett KA, Boortz-Marx RL, Drake JM, et al. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100(6):1582–94.

    Article  PubMed  Google Scholar 

  24. Friese S, Hamhaber U, Erb M, Kueker W, Klose U. The influence of pulse and respiration on spinal cerebrospinal fluid pulsation. Investig Radiol. 2004;39(2):120–30.

    Article  Google Scholar 

  25. Ghafoor VL, Epshteyn M, Carlson GH, Terhaar DM, Charry O, Phelps PK. Intrathecal drug therapy for long-term pain management. Am J Health Syst Pharm. 2007;64(23):2447–61.

    Article  CAS  PubMed  Google Scholar 

  26. Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30(1):37–45.

    Article  PubMed  Google Scholar 

  27. Grider JS, Harned ME, Etscheidt MA. Patient selection and outcomes using a low-dose intrathecal opioid trialing method for chronic nonmalignant pain. Pain Physician. 2011;14(4):343–51.

    PubMed  Google Scholar 

  28. Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol. 2009;53(23):2129–40.

    Article  PubMed  Google Scholar 

  29. Hayek SM, Deer TR, Pope JE, Panchal SJ, Patel VB. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011a;14(3):219–48.

    PubMed  Google Scholar 

  30. Hayek SM, Veizi IE, Narouze SN, Mekhail N. Age-dependent intrathecal opioid escalation in chronic noncancer pain patients. Pain Med. 2011b;12(8):1179–89.

    Article  PubMed  Google Scholar 

  31. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28(3):172–97.

    PubMed  Google Scholar 

  32. Knight KH, Brand FM, Mchaourab AS, Veneziano G. Implantable intrathecal pumps for chronic pain: highlights and updates. Croat Med J. 2007;48(1):22–34.

    PubMed  PubMed Central  Google Scholar 

  33. Manchikanti L. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management, part I: introduction and general considerations. Pain Physician. 2008;11(2):161–86.

    PubMed  Google Scholar 

  34. Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology. 1992;76(1):91–9.

    Article  CAS  PubMed  Google Scholar 

  35. Mekhail N, Mahboobi R, Farajzadeh Deroee A, et al. Factors that might impact intrathecal drug delivery (IDD) dose escalation: a longitudinal study. Pain Pract. 2014;14(4):301–8.

    Article  PubMed  Google Scholar 

  36. Nemeth TA, Beilman GJ, Hamlin CL, Chipman JG. Preoperative verification of timely antimicrobial prophylaxis does not improve compliance with guidelines. Surg Infect. 2010;11(4):387–91.

    Article  Google Scholar 

  37. Ordia JI, Fischer E, Adamski E, Chagnon KG, Spatz EL. Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin. Neuromodulation. 2002;5(1):16–24.

    Article  PubMed  Google Scholar 

  38. Patel VB, Manchikanti L, Singh V, Schultz DM, Hayek SM, Smith HS. Systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain. Pain Physician. 2009;12(2):345–60.

    PubMed  Google Scholar 

  39. Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology. 1992;77(6):1186–2000.

    Article  CAS  PubMed  Google Scholar 

  40. Pergolizzi J, Böger RH, Budd K, Dahan A. Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often …. Pain. 2008. http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2008.00204.x/full.

  41. Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2016;124(3):535–52.

    Article  Google Scholar 

  42. Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354–72; discussion 372.

    Article  PubMed  Google Scholar 

  43. Rathmell JP, Lake T, Ramundo MB. Infectious risks of chronic pain treatments: injection therapy, surgical implants, and intradiscal techniques. Reg Anesth Pain Med. 2006;31(4):346–52.

    PubMed  Google Scholar 

  44. Rauck RL, Wallace MS, Leong MS, et al. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manag. 2006;31(5):393–406.

    Article  CAS  Google Scholar 

  45. Smith HS, Deer TR. Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain. Ther Clin Risk Manag. 2009;5(3):521–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.

    Article  CAS  PubMed  Google Scholar 

  47. Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA. 2004;291(1):63–70.

    Article  CAS  PubMed  Google Scholar 

  48. Stearns L, Boortz-Marx R, Du Pen S, et al. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J Support Oncol. 2005;3(6):399–408.

    CAS  PubMed  Google Scholar 

  49. Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg. 2005;190(5):752–6.

    Article  PubMed  Google Scholar 

  50. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92(3):739–53.

    Article  CAS  PubMed  Google Scholar 

  51. Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest. 2004;114(9):1187–95.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Veizi IE, Hayek SM, Narouze S, Pope JE, Mekhail N. Combination of intrathecal opioids with bupivacaine attenuates opioid dose escalation in chronic noncancer pain patients. Pain Med. 2011;12(10):1481–9.

    Article  PubMed  Google Scholar 

  53. Wang JK. Analgesic effect of intrathecally administered morphine. Reg Anesth Pain Med. 1977;2(3). journals.lww.com):3.

    Google Scholar 

  54. Webster LR, Choi Y, Desai H, Webster L, Grant BJB. Sleep-disordered breathing and chronic opioid therapy. Pain Med. 2008;9(4):425–32.

    Article  PubMed  Google Scholar 

  55. Yaksh TL, Fisher CJ, Hockman TM, Wiese AJ. Current and future issues in the development of spinal agents for the management of pain. Curr Neuropharmacol. 2017;15(2):232–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Interventional Pain Physicians, Chico, CA, USA

    Lucas W. Campos

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  1. Lucas W. Campos
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Editor information

Editors and Affiliations

  1. The Spine and Nerve Center of the Virginias, Charleston, WV, USA

    Timothy R. Deer

  2. Evolve Restorative Center, Santa Rosa, CA, USA

    Jason E. Pope

  3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

    Tim J. Lamer

  4. Pain Diagnostics and Interventional Care, Sewickley, PA, USA

    David Provenzano

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Campos, L.W. (2019). Patient Selection. In: Deer, T., Pope, J., Lamer, T., Provenzano, D. (eds) Deer's Treatment of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-12281-2_80

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  • DOI: https://doi.org/10.1007/978-3-030-12281-2_80

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-12281-2

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