title: Intrathecal infusion systems for long-term management of chronic non-cancer pain: an update of assessment of evidence.
abstract: BACKGROUND
  Intrathecal infusion systems are often used for patients with intractable pain when all else fails, including surgery. There is, however, some concern as to the effectiveness and safety of this treatment.
  
  
  METHODS
  A systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain.
  
  
  OBJECTIVE
  To evaluate and update the effect of intrathecal infusion systems in managing chronic non-cancer pain.
  
  
  METHODS
  The available literature on intrathecal infusion systems in managing chronic pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2012, and manual searches of the bibliographies of known primary and review articles.
  
  
  METHODS
  The primary outcome measure was pain relief with short-term relief < 12 months and long-term relief ≥ 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.
  
  
  RESULTS
  There were 28 studies identified for this systematic review. Of these, 21 were excluded from further review. A total of 7 non-randomized studies met inclusion criteria for methodological quality assessment. No randomized trials met the inclusion requirements.The evidence is limited based on observational studies.
  
  
  CONCLUSIONS
  The limitations of this systematic review include the paucity of literature.
  
  
  CONCLUSIONS
  The evidence is limited for intrathecal infusion systems.
authors.affiliation: Mid Atlantic Spine & Pain Physicians, Newark, DE, USA.
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Falco
authors.forename: Vikram B
authors.initials: VB
authors.lastname: Patel
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Geffert
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Obi
authors.initials: O
authors.lastname: Onyewu
authors.forename: Sareta
authors.initials: S
authors.lastname: Coubarous
authors.forename: Howard S
authors.initials: HS
authors.lastname: Smith
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
mesh_terms: D000777:Anesthetics / Q000008:administration & dosage*; D059350:Chronic Pain / Q000628:therapy*; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
chemical_list: D000777:Anesthetics