Prospective Study of 3-Year Follow-Up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain

Maged Hamza, Daniel Doleys, Mary Wells, Jackie Weisbein, Jeremy Hoff, Michelle Martin, Costa Soteropoulos, Jose Barreto, Steven Deschner, Jessica McKinney Ketchum

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective. Long-term follow-up with the use of low-dose opioids in intrathecal (IT) drug delivery system (DDS) for the treatment of intractable, severe chronic nonmalignant pain. Design. This is a prospective, cohort long-term outcome study. Intervention. The intervention was the implantation of DDS. Method and patients. A total of 61 consecutive patients (60% females, 40% males) with a mean age of 59.2 years and a mean duration of symptoms prior to implant of 6.2 years were referred for implant of DDS for severe intractable noncancer pain. After adequate patient evaluation, each underwent a trial with IT opioids. Three patients failed the trial and 58 patients were implanted. Follow-up was 36 months, with intervals at 6, 12, 18, 24, and 36 months. The Brief Pain Inventory was used for follow-up assessment criteria at baseline prior to implant as well as throughout the duration of the study. Outcome Measures. Outcome measures included self-reported pain scores (worst and average), functional improvement, and IT dose, and oral opioid consumption. Results. We observed a statistically significant reduction in both worst and average pain from baseline (8.91 and 7.47 at baseline) throughout the duration of the study (4.02 and 3.41, respectively, at 36 months) (P=0.012 and P<0.001, respectively). We also documented a statistically significant improvement in physical and behavioral function. All subjects showed a significant reduction in the oral opioid consumption. The dose of IT opioids remained low and virtually unchanged for 36 months of follow-up: 1.4 morphine equivalent/day at 6 months and 1.48 at 36 months. Oral opioid averaged 128.9mg of morphine equivalent/patient/day at baseline to 3.8 at 3 month and remained at the same level throughout the study. Conclusion. Low-dose IT opioid can provide sustained significant improvement in pain and function for long-term follow-up in chronic noncancer pain.

Original languageEnglish (US)
Pages (from-to)1304-1313
Number of pages10
JournalPain Medicine (United States)
Volume13
Issue number10
DOIs
StatePublished - Jan 1 2012

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Chronic Pain
Opioid Analgesics
Prospective Studies
Drug Delivery Systems
Pain
Outcome Assessment (Health Care)
Morphine
Intractable Pain
Equipment and Supplies

Keywords

  • Chronic noncancer pain
  • Intrathecal drug delivery system
  • Long-term follow-up
  • Low dose

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Prospective Study of 3-Year Follow-Up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain. / Hamza, Maged; Doleys, Daniel; Wells, Mary; Weisbein, Jackie; Hoff, Jeremy; Martin, Michelle; Soteropoulos, Costa; Barreto, Jose; Deschner, Steven; Ketchum, Jessica McKinney.

In: Pain Medicine (United States), Vol. 13, No. 10, 01.01.2012, p. 1304-1313.

Research output: Contribution to journalArticle

Hamza, M, Doleys, D, Wells, M, Weisbein, J, Hoff, J, Martin, M, Soteropoulos, C, Barreto, J, Deschner, S & Ketchum, JM 2012, 'Prospective Study of 3-Year Follow-Up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain', Pain Medicine (United States), vol. 13, no. 10, pp. 1304-1313. https://doi.org/10.1111/j.1526-4637.2012.01451.x
Hamza, Maged ; Doleys, Daniel ; Wells, Mary ; Weisbein, Jackie ; Hoff, Jeremy ; Martin, Michelle ; Soteropoulos, Costa ; Barreto, Jose ; Deschner, Steven ; Ketchum, Jessica McKinney. / Prospective Study of 3-Year Follow-Up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain. In: Pain Medicine (United States). 2012 ; Vol. 13, No. 10. pp. 1304-1313.
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abstract = "Objective. Long-term follow-up with the use of low-dose opioids in intrathecal (IT) drug delivery system (DDS) for the treatment of intractable, severe chronic nonmalignant pain. Design. This is a prospective, cohort long-term outcome study. Intervention. The intervention was the implantation of DDS. Method and patients. A total of 61 consecutive patients (60{\%} females, 40{\%} males) with a mean age of 59.2 years and a mean duration of symptoms prior to implant of 6.2 years were referred for implant of DDS for severe intractable noncancer pain. After adequate patient evaluation, each underwent a trial with IT opioids. Three patients failed the trial and 58 patients were implanted. Follow-up was 36 months, with intervals at 6, 12, 18, 24, and 36 months. The Brief Pain Inventory was used for follow-up assessment criteria at baseline prior to implant as well as throughout the duration of the study. Outcome Measures. Outcome measures included self-reported pain scores (worst and average), functional improvement, and IT dose, and oral opioid consumption. Results. We observed a statistically significant reduction in both worst and average pain from baseline (8.91 and 7.47 at baseline) throughout the duration of the study (4.02 and 3.41, respectively, at 36 months) (P=0.012 and P<0.001, respectively). We also documented a statistically significant improvement in physical and behavioral function. All subjects showed a significant reduction in the oral opioid consumption. The dose of IT opioids remained low and virtually unchanged for 36 months of follow-up: 1.4 morphine equivalent/day at 6 months and 1.48 at 36 months. Oral opioid averaged 128.9mg of morphine equivalent/patient/day at baseline to 3.8 at 3 month and remained at the same level throughout the study. Conclusion. Low-dose IT opioid can provide sustained significant improvement in pain and function for long-term follow-up in chronic noncancer pain.",
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AU - Hoff, Jeremy

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