scholarly journals Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

2014 ◽  
pp. 627 ◽  
Author(s):  
Michael Saulino ◽  
Philip Kim ◽  
Erik Shaw
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Patient Selection ◽  
Intrathecal Drug Delivery ◽  
Selection For

Intrathecal drug delivery and neurolytic blocks

2010 ◽  
pp. 137-150
Author(s):  
Karen H. Simpson ◽  
Iain Jones
Keyword(s):  
Drug Delivery ◽  
Side Effects ◽  
Patient Selection ◽  
Local Anaesthetics ◽  
Line Treatment ◽  
Drug Side Effects ◽  
Careful Patient Selection ◽  
Careful Patient ◽  
Intrathecal Drug Delivery ◽  
First Line Treatment

Intrathecal drug delivery (ITDD) allows drugs to be placed near to central receptors Drug side-effects may be reduced as small doses are required compared to with systemic administration External or internal ITDD systems are available ITDD requires careful patient selection and preparation Opioids, local anaesthetics, and clonidine are the most commonly used intrathecal drugs; ziconotide can be used as first line treatment...

scholarly journals Catheter-tip Granulomas Associated with Intrathecal Drug Delivery – A Two-Center Experience Identifying 13 Cases

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E831-E840
Author(s):  
Tobias Kratzsch
Keyword(s):  
Risk Factors ◽  
Drug Delivery ◽  
Chronic Pain ◽  
Drug Therapy ◽  
Smoking Status ◽  
Intrathecal Morphine ◽  
Neurological Deficits ◽  
Intrathecal Drug Delivery ◽  
Catheter Tip

Background: Intrathecal (IT) drug therapy with implanted pumps is an effective treatment modality for chronic pain and/or spasticity, especially after non-invasive treatment has failed. Long-term use of intrathecal opioids may cause formation of inflammatory masses at the tip of intrathecal catheters, possibly leading to neurological deficits and/or catheter revision. Objective: We aimed to identify risk factors for catheter-tip granuloma (CG) formation. Study Design: Retrospective study. Setting: Tertiary Spine Centers in Germany and Switzerland Methods: We retrospectively reviewed data at 2 Swiss centers (Kantonsspital St. Gallen, Swiss Paraplegic Centre Nottwil) between 01/1994 and 10/2013. Collected data were age at operation, gender, smoking status, previous spinal operations, spinal level of catheter-tip, clinical symptoms, catheter testing with contrast agent, applied drugs, drug concentration, as well as cumulative daily drug dosages. Results: Thirteen patients with a mean age of 52.6 years and CG formation after a mean of 6.9 years of follow-up were identified and compared to 54 patients of similar age and length of follow-up (48.6 years, P = 0.535; follow-up 5.3 years, P = 0.236) without CG. In the analysis of risk factors, catheter ending in the middle thoracic spine (Th4-8; 38.5 vs. 6.5%; P = 0.010), previous spinal surgery (75 vs. 41%; P = 0.051), and chronic pain as an underlying primary symptom for IT drug therapy (100 vs. 56%, P = 0.003) were associated with CG formation. IT drug therapy for spasticity appeared to be much less associated with CG formation (0 vs. 44%, P = .0003). As the symptomatology is closely related to the medical treatment applied, patients with CG were more likely to be treated with IT morphine (77 vs. 20%; P < 0.001), and as tendency with IT clonidine (54 vs. 26%; P = 0.092) and IT bupivacaine (46 vs. 20%; P = 0.077). Average in-pump morphine concentration (30.3 vs. 19.5 mg/mL; P = 0.05) as well as average daily dose of morphine (12.5 vs. 6.2 mg/d; P = 0.037) were significantly higher in the CG group. Smoking could not be identified as risk factor for CG formation. Limitations: Limitations include the retrospective approach, the limited group size of granuloma patients, as well as missing data in the investigated patient groups. Conclusion: Our patient cohort with CG differed in some features, of which some like catheter localization, choice, dosage, and the concentration of drugs are potentially modifiable. These results could contribute to the prevention of CG in the future. Key words: Intrathecal drug delivery, intrathecal cathether-tip granuloma, intrathecal cathethertip inflammatory masses, intrathecal morphine, drug pump complications

Intrathecal drug delivery for chronic pain management-scope, limitations and future

2014 ◽  
Vol 29 (2) ◽  
pp. 241-249 ◽  
Author(s):  
M. Czernicki ◽  
G. Sinovich ◽  
I. Mihaylov ◽  
B. Nejad ◽  
S. Kunnumpurath ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Pain Management ◽  
Intrathecal Drug Delivery
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