A Prospective, Randomized, Single-Blinded, Head-to-Head Long-Term Outcome Study, Comparing Intrathecal (IT) Boluses With Continuous Infusion Trialing Techniques Prior to Implantation of Drug Delivery Systems (DDS) for the Treatment of Severe Intractable Chronic Nonmalignant Pain

• Published in: Neuromodulation (Malden, Mass.) Vol. 18; no. 7; p. 636
• Main Authors: Hamza, Maged, Doleys, Daniel M, Saleh, Islam A, Medvedovsky, Andrew, Verdolin, Michael H, Hamza, Monalyce
• Format: Journal Article
• Language: English
• Published: United States 01-10-2015
• Subjects: Affect; Aged; Analgesics - administration & dosage; Analgesics, Opioid - administration & dosage; Chronic Pain - psychology; Chronic Pain - therapy; Cohort Studies; Female; Humans; Infusion Pumps, Implantable - standards; Injections, Spinal - standards; Male; Middle Aged; Outcome Assessment, Health Care; Pain Measurement; Pain, Intractable - drug therapy; Quality of Life; Single-Blind Method; Sleep - drug effects; Time Factors; Walking; Controlled study; nonmalignant pain; trialing for pump implant; placebo controlled; randomized; prospective; intrathecal drug delivery
• ISSN: 1525-1403
• DOI: 10.1111/ner.12342

The study aims to compare intrathecal (IT) boluses to continuous infusion trialing techniques prior to implantation of drug delivery systems (DDS) for the treatment of severe intractable chronic nonmalignant pain.
This is a prospective, randomized, head-to-head long-term outcome study.
Forty patients with comparable patient demographics were randomly assigned to two cohorts. Cohort A trialed with intermittent boluses; Cohort B trialed with continuous infusion. One patient failed trial in each group. Nineteen patients were implanted in each group. Follow-up was for 36 months with intervals at 6, 12, 18, 24, 36 months. The Brief Pain Inventory was used was used for assessment.
We used the Brief Pain Inventory to measure pain (worst and average), physical function (walking, normal work, and general activity), behavioral function (mood, sleep, and relations with others), IT dose, and oral opioid use.
We observed statistically significant reduction in pain and improvement of function in both cohorts following DDS implantation throughout the observation period. The IT dose remained virtually unchanged throughout as well, with overall limited dose escalation. Oral opioid use was significantly reduced. There was no statistically significant difference in prediction of trial success or long-term outcomes between the two cohorts.
Low-dose IT opioids via DDS can provide significant and long-lasting reduction in pain, and improvement in function (physical and behavioral) for patients with chronic nonmalignant pain. The two trialing techniques tested, intermittent boluses, and continuous infusion delivered intrathecally showed no clinical significance difference in terms of predicting trial success or long-term outcomes.