title: Successful Discontinuation of Systemic Opioids After Implantation of an Intrathecal Drug Delivery System.
abstract: BACKGROUND
  An implantable drug delivery system (IDDS) provides an alternate route of opioid administration for patients with chronic pain. We collected data on systemic opioid use before and after IDDS implantation; patients who successfully discontinued systemic opioids; and physician support of discontinuation.
  
  
  METHODS
  This was a single-center, retrospective chart review of 99 consecutive patients who used IDDSs for at least six months. Data collection included pre/postimplant systemic opioid use and pain scores, and patient demographic and clinical characteristics.
  
  
  RESULTS
  The study population averaged 67 years of age, was 68% women, and 77% were Medicare beneficiaries. Ninety-five percent of patients had low back pain, and 86% had limb pain. The majority (81%) had pain for >5 years. Failed treatments included epidural injections (74%), lumbar spine surgery (46%), spinal cord stimulation (14%), and facet joint injections (11%), with 84% also reporting significant systemic opioid side-effects. All patients taking long-acting opioids discontinued these within one month of implant. Total systemic opioid elimination was accomplished by 68% of patients at one month postimplant, 84% at one year, and 92% at five years. At one month postimplant, 60% of patients reported decreased pain (mean change: -4.07), and at one year, 64% did (mean change: -3.42).
  
  
  CONCLUSIONS
  IDDS can provide significant and lasting pain relief and an alternate route of delivery compared with systemic opioids with their associated side-effects. We demonstrated that systemic opioid elimination could be accomplished after IDDS implantation in the majority of cases through appropriate patient selection, monitoring, and participation.
authors.affiliation: Pain Relief Center, St. Mary's Regional Medical Center, Huntington, WV, USA.
authors.forename: David
authors.initials: D
authors.lastname: Caraway
authors.affiliation: Health Economic & Outcomes Research, Optum, Inc., Eden Prairie, MN, USA.
authors.forename: Valery
authors.initials: V
authors.lastname: Walker
authors.affiliation: Health Economic & Outcomes Research, Optum, Inc., Eden Prairie, MN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Becker
authors.affiliation: Neuromodulation Global Reimbursement & Health Economics, HEOR | Medtronic, Inc., Minneapolis, MN, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hinnenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pain; intrathecal drug delivery system; opioids