Initiation of Intrathecal Drug Delivery Dramatically Reduces Systemic Opioid Use in Patients With Advanced Cancer

被引:21
作者
Sindt, Jill E. [1 ]
Odell, Daniel W. [1 ]
Dalley, Andrew P. [1 ]
Brogan, Shane E. [1 ]
机构
[1] Univ Utah, Huntsman Canc Inst, Salt Lake City, UT USA
来源
NEUROMODULATION | 2020年 / 23卷 / 07期
关键词
Cancer pain; intrathecal drug delivery; intrathecal drug delivery system; intrathecal therapy; targeted drug delivery; CONFERENCE PACC RECOMMENDATIONS; COMPREHENSIVE MEDICAL-MANAGEMENT; PAIN-CONTROL; THERAPY; ZICONOTIDE; DIVERSION; ANALGESIA; TOXICITY; EFFICACY; IMPACT;
D O I
10.1111/ner.13175
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objectives Pain is common in cancer, affecting more than 70% of patients with advanced disease. Intrathecal drug delivery systems (IDDS) are a well-established treatment for patients with refractory cancer pain, improving pain control and reducing associated side effects. To date, details of systemic opioid use before and after IDDS implant have not been reported. Materials and Methods We conducted a retrospective review of patients at Huntsman Cancer Institute-University of Utah treated with IDDS for cancer pain from May 2014 to May 2018. Oral, transdermal, and parenteral opioid use before IDDS implant was compared to use 30 days postoperatively. Results A total of 173 patients were included, 93% with stage IV disease. The pre-implant median daily oral morphine equivalent (OME) was 240 mg (interquartile range 130-390, range 0-2616 mg). OME doses >200 mg/day were required by 57% of patients, and >500 mg OME by 19% of patients. The post-implant median OME was 0 mg (interquartile range 0-0, range 0-480 mg) and 82.6% of patients discontinued systemic opioids completely. 11.0% of patients used <100 mg OME, and only 1.7% of patients used >200 mg OME. Mean OME decreased by 94% following IDDS implant (p < 0.0001) and all patients who continued to use systemic opioids required a lower OME compared to pre-implant. Conclusions In the largest cohort of patients with advanced cancer and refractory pain treated with IDDS, implantation was associated with a dramatic reduction in systemic opioid use 30 days postoperatively, with a large majority of patients discontinuing systemic opioids. Those patients that continued systemic opioids utilized significantly lower doses as compared to their pre-implant dose.
引用
收藏
页码:978 / 983
页数:6
相关论文
共 50 条
[41]   Health Services Utilization and Payments in Patients With Cancer Pain: A Comparison of Intrathecal Drug Delivery vs. Conventional Medical Management [J].
Stearns, Lisa J. ;
Hinnenthal, Jennifer A. ;
Hammond, Krisstin ;
Berryman, Eric ;
Janjan, Nora A. .
NEUROMODULATION, 2016, 19 (02) :196-205
[42]   Infectious Complications Related to Intrathecal Drug Delivery System and Spinal Cord Stimulator System Implantations at a Comprehensive Cancer Pain Center [J].
Engle, Mitchell P. ;
Vinh, Baominh P. ;
Harun, Nusrat ;
Koyyalagunta, Dhanalaksmi .
PAIN PHYSICIAN, 2013, 16 (03) :251-257
[43]   Challenges Associated With Spinal Opioid Therapy for Pain in Patients With Advanced Cancer: A Report of Three Cases [J].
Yennurajalingam, Sriram ;
Dev, Rony ;
Walker, Paul W. ;
Reddy, Suresh K. ;
Bruera, Eduardo .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2010, 39 (05) :930-935
[44]   Opioid use disorder in cancer patients [J].
Lewis, Cara E. S. ;
Schutzer-Weissmann, John ;
Farquhar-Smith, Paul .
CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE, 2023, 17 (02) :98-103
[45]   Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note [J].
Zhou, Haocheng ;
Huang, Dong ;
Zou, Dingquan ;
Hu, Junjiao ;
Li, Xinning ;
Wang, Yaping .
DRUG DELIVERY, 2022, 29 (01) :3213-3217
[46]   Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain [J].
Yang, CY ;
Wong, CS ;
Chang, JY ;
Ho, ST .
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 1996, 43 (04) :379-383
[47]   Management of Refractory Cancer Pain with Intrathecal Drug Delivery and Spinal Cord Stimulation [J].
Bulat, Evgeny ;
Crowther, Jason E. ;
Chakravarthy, Vikram ;
Laufer, Ilya ;
Barzilai, Ori ;
Gulati, Amitabh .
PALLIATIVE MEDICINE REPORTS, 2024, 5 (01) :301-305
[48]   Early buprenorphine-naloxone initiation for opioid use disorder reduces opioid overdose, emergency room visits and healthcare cost compare to late initiation [J].
Sun, Tianyu ;
Aroke, Hilary ;
Kogut, Stephen ;
Katenka, Natallia ;
Bratberg, Jeffrey ;
Buchanan, Ashley .
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE, 2022, 48 (02) :217-225
[49]   Intrathecal drug-infusion system for treating pain in advanced cancer: New research in patient management [J].
Chen, Mei-gui ;
Xiu, Min ;
Yang, Lei ;
Jin, Hai-yan ;
Deng, Li-hua ;
Li, Yi ;
Chen, Peng .
INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS, 2024, 62 (01) :37-47
[50]   The Association of Drug-Funding Reimbursement With Survival Outcomes and Use of New Systemic Therapies Among Patients With Advanced Pancreatic Cancer [J].
Raphael, Michael J. ;
Raskin, William ;
Habbous, Steven ;
Tai, Xiaochen ;
Beca, Jaclyn ;
Dai, Wei F. ;
Arias, Jessica ;
Forbes, Leta ;
Gavura, Scott ;
Biagi, James J. ;
Earle, Craig C. ;
Chan, Kelvin K. W. .
JAMA NETWORK OPEN, 2021, 4 (11) :E2133388