title: Intrathecal pain pump infusions for intractable cancer pain: an algorithm for dosing without a neuraxial trial.
abstract: BACKGROUND
  Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay.
  
  
  METHODS
  We used data pre- and postpump from 46 cancer patients receiving systemic opioids undergoing intrathecal pump placement in the last 6 years, all of whom had undergone an epidural trial before pump placement.
  
  
  RESULTS
  By analyzing intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancer patients, an appropriate initial dose for an intrathecal pump based on the prepump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible.
  
  
  CONCLUSIONS
  When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.
authors.affiliation: Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA. malhotrv@mskcc.org
authors.forename: Vivek Tim
authors.initials: VT
authors.lastname: Malhotra
authors.forename: James
authors.initials: J
authors.lastname: Root
authors.forename: Joseph
authors.initials: J
authors.lastname: Kesselbrenner
authors.forename: Innocent
authors.initials: I
authors.lastname: Njoku
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cubert
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gulati
authors.forename: Vinay
authors.initials: V
authors.lastname: Puttanniah
authors.forename: Mark
authors.initials: M
authors.lastname: Bilsky
authors.forename: Michael
authors.initials: M
authors.lastname: Kaplitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007278:Injections, Spinal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D010148:Intractable Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid
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