Intravenous infusion tests have limited utility for selecting long-term drug therapy in patients with chronic pain: a systematic review.
Since the first description in the early 1990s, the scope of intravenous infusions tests has expanded to encompass multiple drug classes and indications. Purported advantages of these tests include elucidating mechanisms of pain, providing temporary relief of symptoms, and usefulness as prognostic tools in guiding drug therapy. In an attempt to discern the value of these tests, the authors conducted a systematic review to explore the rationale and evidence behind the following intravenous infusion tests: lidocaine, ketamine, opioid, and phentolamine. The studies evaluating all intravenous infusion tests were characterized by lack of standardization, wide variations in outcome measures, and methodological flaws. The strongest evidence found was for the intravenous lidocaine test, with the phentolamine test characterized by the least convincing data. Whereas intravenous opioid infusions are the most conceptually appealing test, their greatest utility may be in predicting poor responders to sustained-release formulations.
Cohen
Steven P
SP
Pain Management Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland 21029, USA. scohen40@jhmi.edu
Kapoor
Shruti G
SG
Rathmell
James P
JP
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008134:Long-Term Care; D010146:Pain / Q000188:drug therapy*; D010646:Phentolamine / Q000008:administration & dosage / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D000779:Anesthetics, Local; D007649:Ketamine; D008012:Lidocaine; D010646:Phentolamine