Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain.

Background: Chronic persistent pain as a result of terminal illness, either as a consequence of the disease or the necessary treatment, is common in patients with cancer. For these patients with moderate-to-severe intractable pain, intrathecal (IT) drug delivery systems may represent an effective option for pain management. Thus, IT drug delivery is a viable treatment strategy for both neuropathy and nociceptive pain in the cancer population.

Prospective clinical study of a new implantable peripheral nerve stimulation device to treat chronic pain.

Objectives: To evaluate clinical use of the StimRouter, an investigational implanted peripheral nerve stimulator for treating chronic neuropathic pain, using the median nerve as a model for that general application.

Methods: Eight patients with carpal tunnel syndrome and chronic pain despite both carpal tunnel release and treatment with oral pain medications were enrolled in a single-center, open-label trial after institutional review board approval. Primary endpoints were successful implantation near the target peripheral nerve and safety.

Spinal cord stimulation as a method of reducing opioids in severe chronic pain: a case report and review of the literature.

Opioid addiction and abuse are growing problems in the United States, particularly in Appalachian areas, which has led to a major social health problem costing millions of dollars in lost wages, medical care and lost productivity. In some patients with chronic moderate to severe pain, opioids are indicated and can be successfully used with proper monitoring. In this report, we present a case where the use of spinal cord stimulation (SCS) led to an elimination of opioids, a return to work, and to productive function.

Intrathecal ziconotide and opioid combination therapy for noncancer pain: an observational study.

Background: Intrathecal ziconotide is used to manage severe chronic pain. Although ziconotide is approved by the US Food and Drug Administration for monotherapy, it is sometimes used in combination with other intrathecal drugs for the management of intractable pain conditions in clinical practice.

Objectives: Evaluate the safety and tolerability of ziconotide combination therapy.

Practice choices and challenges in the current intrathecal therapy environment: an online survey.

Objective: The objective of this study was to evaluate current practice characteristics, treatment choices, clinical experiences, and economic concerns associated with intrathecal therapy.

Design: Health care professionals in the United States, who were known to actively use intrathecal therapy in their practices, were recruited to participate in an online survey; contact information was obtained via Internet searches, university Websites, association memberships, industry databases, and personal contacts. Survey responses were summarized descriptively.

Inflammatory mass of an intrathecal catheter in patients receiving baclofen as a sole agent: a report of two cases and a review of the identification and treatment of the complication.

Introduction: Intrathecal inflammatory masses or granuloma have been described extensively in the literature in patients receiving chronic spinal infusions for pain. After an extensive literature review, no reported cases of baclofen causing this disorder when administered as a sole agent were identified. Intrathecal baclofen has been used to treat spasticity secondary to stroke, multiple sclerosis, cerebral palsy, spinal cord injury, and other neurological disease.

Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease.

Spinal cord stimulation has been used in clinical practice for more than three decades. The primary use of this therapy has been in spine-related disorders. In recent years, the therapy has been used more extensively in diseases of the vascular system.

The use of continuous intrathecal infusion of octreotide in patients with chronic pain of noncancer origin: an evaluation of efficacy in a prospective double-blind fashion.

Objective.  We evaluated the efficacy of octreotide when administered in a continuous fashion by intrathecal infusion. Materials and Methods.

The Use of Continuous Intrathecal Infusion of Octreotide in Patients with Chronic Pain of Noncancer Origin: An Evaluation of Side-effects and Toxicity in a Prospective Double-blind Fashion.

Introduction.  Intrathecal octreotide has been considered an alternative to opioids in chronic infusion for pain. Octreotide is an analog of the growth hormone sandostatin.

Prevention of intrathecal drug delivery catheter-related complications.

In an effort to improve the performance of implantable intrathecal drug delivery systems, a group of physicians experienced in the management of such devices reviewed surgical practices and principles that were associated with low catheter-related complication rates. Clinical study and postmarket data identified physicians whose patients experienced a relatively low rate of catheter-related complications. Six of those physicians (three anesthesiologists and three neurosurgeons) reviewed the number and types of intrathecal drug pumps and catheters they had implanted, with an emphasis on the specific details of successful catheter implantation techniques.

Intrathecal bupivacaine for chronic pain: a review of current knowledge.

Objective. This article presents an overview of the use of intrathecal bupivacaine (with and without opioid), focusing on laboratory data and clinical use for chronic pain. Some background on epidural use is included to support the intrathecal literature.

Intrathecal therapy for cancer and nonmalignant pain: patient selection and patient management.

Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the "gold standard," and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes.