title: The effects of long-term intraspinal infusion therapy with noncancer pain patients: evaluation of patient, significant-other, and clinic staff appraisals.
abstract: Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy, primarily using opioids, in the treatment of recalcitrant noncancer pain in a sample of 29 consecutive patients. Patients were, on average, 58 years of age having had one surgery, with a pain duration of 221 months. Mean follow-up duration was 31 months. Telephone interviews by a disinterested party were used to obtain follow-up data from patients and their significant others. In addition, clinic staff rated patient improvement. Results. The patients reported an average of 63.4% improvement in pain; 45.5% improvement in activity level; and a 53.8% improvement in "ease" of performing activities. Average pain level on a numerical rating scale decreased from 8.91/10 to 5.03/10. The number of patients reporting a pain level of 5/10 or less increased from 1/29 to 15/29. Patients generally reported long-term benefit to be equal to or greater than that realized during the intrathecal trial. Approximately 86% of patients reported a "good" or "excellent" outcome. Significant-other ratings of improvement correlated more highly with clinic staff than with patients. No statistically significant differences were observed when worker's compensation (WC) patients were compared with nonworker's compensation (NWC) patients. Nearly 50% of the patients reported some type of transient or persistent side effect, mostly related to the infused substance. No mechanical failure of the DAS system was observed. Conclusion. These results in part replicate those from previous studies examining the long-term effects of infusion therapy. Side effects remain fairly common and require continued attention. Their presence, however, did not appear to deter from the patient's overall sense of satisfaction. Acquiring information from significant others and clinic staff may be a useful adjunct in interpreting the overall outcome.
authors.affiliation: Alabama Pain Center, Huntsville, Alabama and                    Pain and Rehabilitation Institute, Birmingham, Alabama.
authors.forename: K D
authors.initials: KD
authors.lastname: Willis
authors.forename: D M
authors.initials: DM
authors.lastname: Doleys