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Neuromodulation. 2015 Aug;18(6):508-15; discussion 515-6. doi: 10.1111/ner.12318. Epub 2015 Jun 5.

Successful Discontinuation of Systemic Opioids After Implantation of an Intrathecal Drug Delivery System.

Author information

1
Pain Relief Center, St. Mary's Regional Medical Center, Huntington, WV, USA.
2
Health Economic & Outcomes Research, Optum, Inc., Eden Prairie, MN, USA.
3
Neuromodulation Global Reimbursement & Health Economics, HEOR | Medtronic, Inc., Minneapolis, MN, USA.

Abstract

INTRODUCTION:

An implantable drug delivery system (IDDS) provides an alternate route of opioid administration for patients with chronic pain. We collected data on systemic opioid use before and after IDDS implantation; patients who successfully discontinued systemic opioids; and physician support of discontinuation.

METHODS:

This was a single-center, retrospective chart review of 99 consecutive patients who used IDDSs for at least six months. Data collection included pre/postimplant systemic opioid use and pain scores, and patient demographic and clinical characteristics.

RESULTS:

The study population averaged 67 years of age, was 68% women, and 77% were Medicare beneficiaries. Ninety-five percent of patients had low back pain, and 86% had limb pain. The majority (81%) had pain for >5 years. Failed treatments included epidural injections (74%), lumbar spine surgery (46%), spinal cord stimulation (14%), and facet joint injections (11%), with 84% also reporting significant systemic opioid side-effects. All patients taking long-acting opioids discontinued these within one month of implant. Total systemic opioid elimination was accomplished by 68% of patients at one month postimplant, 84% at one year, and 92% at five years. At one month postimplant, 60% of patients reported decreased pain (mean change: -4.07), and at one year, 64% did (mean change: -3.42).

CONCLUSIONS:

IDDS can provide significant and lasting pain relief and an alternate route of delivery compared with systemic opioids with their associated side-effects. We demonstrated that systemic opioid elimination could be accomplished after IDDS implantation in the majority of cases through appropriate patient selection, monitoring, and participation.

KEYWORDS:

Chronic pain; intrathecal drug delivery system; opioids

PMID:
26053626
DOI:
10.1111/ner.12318
[Indexed for MEDLINE]

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