Consensus guidelines for the selection and implantation of patients with noncancer pain for intrathecal drug delivery.
Intrathecal therapy offers an invasive alternative for the long-term management of select patients with intractable pain associated with various disease states, including those of noncancer origin. It is commonly accepted that proper patient selection is essential to optimizing treatment outcomes, yet the practice of candidate selection for device implantation varies widely. A multifaceted approach--with consideration of preexisting medical comorbidities; psychological status; associated social, technical, and economic issues; and response to intrathecal trialing--enables practitioners to fully evaluate the appropriateness of implanting a patient with an intrathecal drug delivery system. Yet, to date no standard set of guidelines have been developed to aid practitioners in navigating this evaluation process. Using experience- and knowledge-based expert opinion to systematically evaluate the available evidence, this article provides consensus guidelines aimed at optimizing the selection of patients with noncancer pain for intrathecal therapy. In conclusion, complete assessment of a patient's physical, psychological, and social characteristics, can guide practitioners in determining the appropriateness of initiating intrathecal therapy. These consensus guidelines are intended to assist with weighing this risk/benefit ratio of intrathecal therapy, thereby minimizing the potential for treatment failure, unacceptable adverse effects, and excess mortality.
Deer
Timothy R
TR
Center for Pain Relief, Inc, Charleston, West Virginia 25301, USA. DocTDeer@aol.com
Smith
Howard S
HS
Cousins
Michael
M
Doleys
Daniel M
DM
Levy
Robert M
RM
Rathmell
James P
JP
Staats
Peter S
PS
Wallace
Mark
M
Webster
Lynn R
LR
D000465:Algorithms; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000925:Anticoagulants / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications / Q000188:drug therapy; D002908:Chronic Disease; D016503:Drug Delivery Systems; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D007239:Infections / Q000150:complications; D007278:Injections, Spinal; D007674:Kidney Diseases / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D009765:Obesity / Q000150:complications; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D018579:Patient Selection; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000209:etiology; D019966:Substance-Related Disorders / Q000150:complications
D000700:Analgesics; D000701:Analgesics, Opioid; D000925:Anticoagulants