Intrathecal Drug Delivery for the Treatment of Cancer‐Associated Chronic Pain in Children

2021 ◽  
Author(s):  
Meaghan Kenfield ◽  
Nicholas Zacharias ◽  
Alaa Abd‐Elsayed
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Intrathecal Drug Delivery

scholarly journals Catheter-tip Granulomas Associated with Intrathecal Drug Delivery – A Two-Center Experience Identifying 13 Cases

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E831-E840
Author(s):  
Tobias Kratzsch
Keyword(s):  
Risk Factors ◽  
Drug Delivery ◽  
Chronic Pain ◽  
Drug Therapy ◽  
Smoking Status ◽  
Intrathecal Morphine ◽  
Neurological Deficits ◽  
Intrathecal Drug Delivery ◽  
Catheter Tip

Background: Intrathecal (IT) drug therapy with implanted pumps is an effective treatment modality for chronic pain and/or spasticity, especially after non-invasive treatment has failed. Long-term use of intrathecal opioids may cause formation of inflammatory masses at the tip of intrathecal catheters, possibly leading to neurological deficits and/or catheter revision. Objective: We aimed to identify risk factors for catheter-tip granuloma (CG) formation. Study Design: Retrospective study. Setting: Tertiary Spine Centers in Germany and Switzerland Methods: We retrospectively reviewed data at 2 Swiss centers (Kantonsspital St. Gallen, Swiss Paraplegic Centre Nottwil) between 01/1994 and 10/2013. Collected data were age at operation, gender, smoking status, previous spinal operations, spinal level of catheter-tip, clinical symptoms, catheter testing with contrast agent, applied drugs, drug concentration, as well as cumulative daily drug dosages. Results: Thirteen patients with a mean age of 52.6 years and CG formation after a mean of 6.9 years of follow-up were identified and compared to 54 patients of similar age and length of follow-up (48.6 years, P = 0.535; follow-up 5.3 years, P = 0.236) without CG. In the analysis of risk factors, catheter ending in the middle thoracic spine (Th4-8; 38.5 vs. 6.5%; P = 0.010), previous spinal surgery (75 vs. 41%; P = 0.051), and chronic pain as an underlying primary symptom for IT drug therapy (100 vs. 56%, P = 0.003) were associated with CG formation. IT drug therapy for spasticity appeared to be much less associated with CG formation (0 vs. 44%, P = .0003). As the symptomatology is closely related to the medical treatment applied, patients with CG were more likely to be treated with IT morphine (77 vs. 20%; P < 0.001), and as tendency with IT clonidine (54 vs. 26%; P = 0.092) and IT bupivacaine (46 vs. 20%; P = 0.077). Average in-pump morphine concentration (30.3 vs. 19.5 mg/mL; P = 0.05) as well as average daily dose of morphine (12.5 vs. 6.2 mg/d; P = 0.037) were significantly higher in the CG group. Smoking could not be identified as risk factor for CG formation. Limitations: Limitations include the retrospective approach, the limited group size of granuloma patients, as well as missing data in the investigated patient groups. Conclusion: Our patient cohort with CG differed in some features, of which some like catheter localization, choice, dosage, and the concentration of drugs are potentially modifiable. These results could contribute to the prevention of CG in the future. Key words: Intrathecal drug delivery, intrathecal cathether-tip granuloma, intrathecal cathethertip inflammatory masses, intrathecal morphine, drug pump complications

Intrathecal drug delivery for chronic pain management-scope, limitations and future

2014 ◽  
Vol 29 (2) ◽  
pp. 241-249 ◽  
Author(s):  
M. Czernicki ◽  
G. Sinovich ◽  
I. Mihaylov ◽  
B. Nejad ◽  
S. Kunnumpurath ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Pain Management ◽  
Intrathecal Drug Delivery

scholarly journals Medical Device Related Pressure Injury in the Treatment of Chronic Pain: An Early Sign of Explantation in Suspected Infection

2018 ◽  
Vol 1 (21;1) ◽  
pp. E235-E246 ◽  
Author(s):  
Nerea Sanchis-López
Keyword(s):  
Drug Delivery ◽  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Study ◽  
Medical Device ◽  
Spinal Cord Stimulation ◽  
Secondary Outcome ◽  
Intrathecal Drug Delivery ◽  
Pressure Injury ◽  
Hospital General

Background Chronic back pain is a prevalent disease and has a high impact in daily life. Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS) systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased exponentially in the last decade. The number of complications, such as infections, are also more prevalent. Infection management guidelines are needed to standarize our clinical practice and define protocols of explantation. Objectives: The primary outcome is to define the likelihood of device explantation regarding some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary outcome is to evaluate performance compared to the results published in the literature. Study Design: Retrospective study. Setting: Hospital General of Valencia. Valencia. Spain. Methods: A retrospective study of 288 implantable device surgeries was conducted at the Hospital General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data were collected. We have followed the “guidelines for the diagnosis, prevention and management of implantable electronic cardiac device infection” due to the lack of a specific guideline in our field. Results: Forty-three out of 288 procedures were identified as suspected device-infected interventions. Half of the patients had microbiologically confirmed infection after wound, blood or lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on discharge also played a role in the decision of device explantation. Limitations: Lack of external validity and others. Conclusion: In this study, presence of decubitus is the defining variable for device explantation when a infection is suspected rather than waiting to culture results. Due to a high variability in infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on accurate data monitoring, rigurous implantation technique and standardized protocols. Key Words: Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug delivery pump, complication, infection, explantation

scholarly journals Use of Color Flow Doppler Ultrasonography to Increase the Safety of Intrathecal Drug Delivery System Refills

2019 ◽  
pp. 173-177
Author(s):  
Ankur D. Mehta
Keyword(s):  
Drug Delivery ◽  
Chronic Pain ◽  
Drug Delivery Systems ◽  
Doppler Ultrasonography ◽  
Delivery Systems ◽  
Ultrasound Images ◽  
Common Procedure ◽  
Color Flow ◽  
Intrathecal Drug Delivery ◽  
Flow Leak

Intrathecal drug delivery systems are effective tools in the treatment of chronic pain or spasticity. Using intrathecal drug delivery systems, drugs are directly infused into the cerebrospinal fluid and gain access to critical receptors in the central nervous system. This delivery method allows for the use of markedly reduced doses of medications to produce the same effects as seen with higher orally administered doses. Reduced dosing produces fewer side effects, creating a more favorable treatment course for patients already suffering from chronic pain or spasticity. Complications with intrathecal drug delivery systems can occur during both the implantation process and the postoperative maintenance of the device. The most common procedure carried out during postoperative maintenance of these devices is the intrathecal pump refill. This procedure must be performed by experienced practitioners in a systematic way in order to prevent complications. The most dreaded of these complications is inadvertent injection of medication into the subcutaneous space as opposed to into the device, commonly referred to as a “pocket fill.” This paper describes and recommends the routine use of color flow doppler ultrasonography as an easy, safe, and effective tool to reduce the chance of a catastrophic “pocket fill.” Routine utilization of live color flow ultrasound guidance during pump refills allows the practitioner to carefully document flow of medication into the pump under the silicone septum. It also allows for demonstration of no leakage from, or fluid increase superficial to, the septum. Additionally, 2 ultrasound images are obtained to document color flow deep to the septum and no color flow/leak/fluid superficial to the septum. Although this complication is rare, it can lead to severe complications including oversedation, respiratory depression, and death. As such, we believe that the utilization of color phase doppler ultrasonography could further reduce this incidence. Key words: Analgesics, opioids, chronic pain, drug overdose, infusion pumps, implantable, injections, spinal, medication errors, spasticity, ultrasonics, methods, ultrasonography, interventional

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