Abstract
IDDS can offer pain relief for a broad range of chronic pain states including neuropathies, complex regional pain syndrome, rheumatoid arthritis, connective tissue disorders, chronic pancreatitis, and other visceral pain diseases. These devices can dramatically improve the quality of life for patients who have failed oral or transdermal medications (either due to poor analgesia or intolerable side effects) and/or spinal cord stimulation.
The FDA originally approved infusions of morphine and baclofen in IDDS. However, morphine alone failed to provide adequate analgesia in many patients. Clinician began to add adjuncts to the infusions to improve pain control. With time, more data became available to assess the effectiveness and safety of adjunct medications. An expert panel convened to review these practices and developed an algorithm for IDDS medication management. Since the 1990s, several medications have been infused through the IDDS including bupivacaine, ziconotide, clonidine, midazolam, ketamine, tetracaine, hydromorphone, fentanyl, sufentanil, gabapentin, and other drugs. Animal toxicity data and human safety information have been studied for many of these agents.
IDDS have improved the quality of life for a variety of patients. In 2006, a cluster of patients were noted to suffer respiratory arrest and death 1 day after implantation of IDDS. This prompted a review of the literature to define the mortality associated with IDDS. The investigators identified several physician practices that increased patients’ risk of mortality in the perioperative period. An expert panel convened and developed guidelines to improve the safety of IDDS.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Medtronic marketing data. Minneapolis, MN: Medtronic; 2013.
Hayek SM, Deer TR, Pope JE, Panchal SJ, Patel V. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011;14:219–48.
Eisenach JC, Hood DD, Curry R. Intrathecal but not intravenous opioids release adenosine from the spinal cord. Pain. 2004;5:64–8.
Bernards CM. Cerebrospinal fluid and spinal cord distribution of baclofen and bupivacaine during slow intrathecal infusion in pigs. Anesthesiology. 2006;105:169–78.
Smith TJ, Staats PS, Deer T. 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;18:4040–9.
Deer T, Chapple I, Classen A, Javery K, Stoker V, Tonder L, Burchiel K. Intrathecal drug delivery for treatment of chronic low back pain: report from the national outcomes registry for low back pain. Pain Med. 2004;5:6–13.
Bennett G, Burchiel K, Buchser E, Classen A, Deer T, DuPen S, Ferrante M, Hassenbusch S, Lou L, Maeyaert J, Penn R, Portenoy R, Rauck R, Serafini M, Willis D, Yaksh T. Clinical guidelines for intraspinal infusion: a report of an expert panel. PolyAnalgesic consensus conference 2000. J Pain Symptom Manag. 2000;20:S37–43.
Hassenbusch SJ, Portenoy RK, Cousins M, Buchser E, Deer TR, DuPen SL, Eisenach J, Follett KA, Hildebrand KR, Krames ES, Levy RM, Palmer PP, Rathmel JP, Rauck RL, Staats PS, Stearns L, Willis KD. Polyanalgesic consensus conference 2003: an update on the management of pain by intraspinal drug delivery-report of an expert panel. J Pain Symptom Manag. 2004;27(6):540–63.
Deer TR, Levy R, Prager J, Buchser E, Burton A, Caraway D, Cousins M, DeAndres J, Sudhir D, Erdek M, Grigsby E, Hutoon M, Jacobs M, Kim P, Kumar K, Leong M, Liem L, McDowell GC, Panchal S, Rauck R, Saulino M, Sitzman BT, Staats P, Staton-Hicks M, Stears L, Wallace M, Willis KD, Witt W, Yaksh T, Mekhail N. Polyanalgesic consensus conference-2012: recommendations to reduce morbidity and mortality in intrathecal drug delivery in the treatment of chronic pain. Neuromodulation. 2012;15:467–82.
Dahm P, Lundborg C, Janson M, Olegard C, Nitescu P. Comparison of 0.5% intrathecal bupivacaine with 0.5% intrathecal ropivacaine in the treatment of refractory cancer and noncancer pain conditions: results from a prospective, crossover, double-blind, randomized study. Reg Anesth Med. 2000;25:480–7.
Staats P, Yearwood T, Charapata SG, Presley RW, Wallace MS, Byas-Smith M, Fisher R, Bryce DA, Mangieri EA, Luther RR, May M, McGuire D, Ellis D. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA. 2004;291:63–70.
Mironer YE, Grumman S. Experience with alternative solutions in intrathecal treatment of chronic nonmalignant pain. Pain Digest. 1999;9:299–302.
Mironer YE, Tollison CD. Methadone in the intrathecal treatment of chronic nonmalignant pain resistant to other neuro- axial agents: the first experience. Neuromodulation. 2001;4:25–31.
Hassenbusch SJ, Gunes S, Wachsman S, Willis D. Intrathecal clonidine in the treatment of intractable pain: a phase I/II study. Pain Med. 2002;3:85–91.
Ackerman LL, Follett KA, Rosenquist RW. Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations. J Pain Symptom Manag. 2003;26:668–77.
Kroin JS, McCarthy RJ, Penn RD, Lubenow TJ, Ivankovich AD. Intrathecal clonidine and tizanidine in conscious dogs: comparison of analgesic and hemodynamic effects. Anesth Analg. 1996;82:627–35.
Deer TR, Penn R, Kim CK, Bowman RG, Norris M, Stewart CD, Garten TG, Tolentino W, Khan Y. The use of continuous intrathecal infusion of octreotide in patients with chronic pain of noncancer origin: an evaluation of efficacy in a prospective double blind fashion. Neuromodulation. 2006;8:284–9.
Wallin J, Cui JG, Yakhnitsa V, Schechtmann G, Meyerson B, Linderoth B. Gabapentin and pregabalin suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy. Eur J Pain. 2002;6:261–72.
Coffey RJ, Owens ML, Broste SK, Dubois MY, Ferrante FM, Schultz DM, Stearns LJ, Turner MS. Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat non-cancer pain. Anesthesiology. 2009;111:881–91.
Prager J, Deer T, Levy R, Bruel B, Buchser E, Caraway D, Cousins M, Jacobs M, McGlothen G, Rauck R, Staats P, Steans L. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17:354–72.
Deer T. A prospective analysis of intrathecal granuloma in chronic pain patients: a review of the literature and report of a surveillance study. Pain Physician. 2004;7:225–8.
Yaksh TL, Horais KA, Tozier NA. Chronically infused intrathecal morphine in dogs. Anesthesiology. 2003;99:174–87.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Beckerly, R. (2018). Complications of Intrathecal Polypharmacy, Medication Side Effects, and Overdose. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_31
Download citation
DOI: https://doi.org/10.1007/978-3-319-60072-7_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-60070-3
Online ISBN: 978-3-319-60072-7
eBook Packages: MedicineMedicine (R0)