Physician Guidance on the Use of Off‐Labeled Drugs in Intrathecal Drug Delivery Systems for Chronic Pain

2019 ◽  
Vol 22 (7) ◽  
pp. 765-768
Author(s):  
Timothy Deer ◽  
Phillip Kim ◽  
Jason E. Pope ◽  
Salim Hayek ◽  
Gladstone McDowell ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Drug Delivery Systems ◽  
Delivery Systems ◽  
Intrathecal Drug Delivery

scholarly journals Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

2019 ◽  
pp. 173-177
Author(s):  
Ankur D. Mehta
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Drug Delivery Systems ◽  
Doppler Ultrasonography ◽  
Delivery Systems ◽  
Ultrasound Images ◽  
Common Procedure ◽  
Color Flow ◽  
Intrathecal Drug Delivery ◽  
Flow Leak

Intrathecal drug delivery systems are effective tools in the treatment of chronic pain or spasticity. Using intrathecal drug delivery systems, drugs are directly infused into the cerebrospinal fluid and gain access to critical receptors in the central nervous system. This delivery method allows for the use of markedly reduced doses of medications to produce the same effects as seen with higher orally administered doses. Reduced dosing produces fewer side effects, creating a more favorable treatment course for patients already suffering from chronic pain or spasticity. Complications with intrathecal drug delivery systems can occur during both the implantation process and the postoperative maintenance of the device. The most common procedure carried out during postoperative maintenance of these devices is the intrathecal pump refill. This procedure must be performed by experienced practitioners in a systematic way in order to prevent complications. The most dreaded of these complications is inadvertent injection of medication into the subcutaneous space as opposed to into the device, commonly referred to as a “pocket fill.” This paper describes and recommends the routine use of color flow doppler ultrasonography as an easy, safe, and effective tool to reduce the chance of a catastrophic “pocket fill.” Routine utilization of live color flow ultrasound guidance during pump refills allows the practitioner to carefully document flow of medication into the pump under the silicone septum. It also allows for demonstration of no leakage from, or fluid increase superficial to, the septum. Additionally, 2 ultrasound images are obtained to document color flow deep to the septum and no color flow/leak/fluid superficial to the septum. Although this complication is rare, it can lead to severe complications including oversedation, respiratory depression, and death. As such, we believe that the utilization of color phase doppler ultrasonography could further reduce this incidence. Key words: Analgesics, opioids, chronic pain, drug overdose, infusion pumps, implantable, injections, spinal, medication errors, spasticity, ultrasonics, methods, ultrasonography, interventional

scholarly journals Intrathecal Drug Delivery Systems for the Management of Chronic Noncancer Pain: A Systematic Review of Economic Evaluations

Pain Practice ◽  
2017 ◽  
Vol 18 (5) ◽  
pp. 666-686 ◽  
Author(s):  
Rui V. Duarte ◽  
Tosin Lambe ◽  
Jon H. Raphael ◽  
Sam Eldabe ◽  
Lazaros Andronis
Keyword(s):  
Systematic Review ◽  
Drug Delivery ◽  
Drug Delivery Systems ◽  
Delivery Systems ◽  
Economic Evaluations ◽  
Chronic Noncancer Pain ◽  
Intrathecal Drug Delivery ◽  
Noncancer Pain

scholarly journals Intrathecal drug delivery systems for the management of chronic non-cancer pain: protocol for a systematic review of economic evaluations

BMJ Open ◽  
2016 ◽  
Vol 6 (7) ◽  
pp. e012285 ◽  
Author(s):  
Rui V Duarte ◽  
Tosin Lambe ◽  
Jon H Raphael ◽  
Sam Eldabe ◽  
Lazaros Andronis
Keyword(s):  
Systematic Review ◽  
Drug Delivery ◽  
Cancer Pain ◽  
Drug Delivery Systems ◽  
Delivery Systems ◽  
Economic Evaluations ◽  
Intrathecal Drug Delivery
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