title: Prospective study of 3-year follow-up of low-dose intrathecal opioids in the management of chronic nonmalignant pain.
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.
  
  
  METHODS
  This is a prospective, cohort long-term outcome study. Intervention.  The intervention was the implantation of DDS.
  
  
  METHODS
  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.
  
  
  METHODS
  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 128.9 mg of morphine equivalent/patient/day at baseline to 3.8 at 3 month and remained at the same level throughout the study.
  
  
  CONCLUSIONS
  Low-dose IT opioid can provide sustained significant improvement in pain and function for long-term follow-up in chronic noncancer pain.
authors: Virginia Commonwealth University Spine Center, Richmond, VA 23235, USA. maged.hamza@gmail.com.
authors: Maged
authors: M
authors: Hamza
authors: Daniel
authors: D
authors: Doleys
authors: Mary
authors: M
authors: Wells
authors: Jackie
authors: J
authors: Weisbein
authors: Jeremy
authors: J
authors: Hoff
authors: Michelle
authors: M
authors: Martin
authors: Costa
authors: C
authors: Soteropoulos
authors: Jose
authors: J
authors: Barreto
authors: Steven
authors: S
authors: Deschner
authors: Jessica
authors: J
authors: Ketchum
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid