Long-term Outcomes Using Intrathecal Drug Delivery Systems in Complex Regional Pain Syndrome.

Autor:	Herring EZ; Case Western Reserve University School of Medicine, Cleveland, Ohio., Frizon LA; Center for Neurological Restoration., Hogue O; Quantitative Health Sciences., Mejia JU; Case Western Reserve University School of Medicine, Cleveland, Ohio., Rosenquist R; Pain Management., Bolash RB; Pain Management and Evidence Based Pain Research., Machado AG; Center for Neurological Restoration.; Department of Neurosurgery, Cleveland Clinc, Cleveland, Ohio, USA., Nagel SJ; Center for Neurological Restoration.; Department of Neurosurgery, Cleveland Clinc, Cleveland, Ohio, USA.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2019 Mar 01; Vol. 20 (3), pp. 515-520.
DOI:	10.1093/pm/pny104
Abstrakt:	Objective: Providing durable long-term pain control for patients with complex regional pain syndrome (CRPS) is challenging. A multidisciplinary approach focused on physical therapy is frequently prescribed, with opioids and invasive procedures reserved for those challenged by functional progression. In this study, we examined the long-term efficacy of intrathecal drug delivery systems (IDDS) in patients with CRPS at our institution. Methods: Patients with CRPS implanted with an IDDS between 2000 and 2013 who had four or more years of continuous follow-up were included in the analysis. The outcome variables of interest were pain intensity and oral opioid intake. The primary predictor of interest was dose of intrathecal opioids, with ziconotide, bupivacaine, and clonidine characterized as binary secondary predictors. Results: Of the 1,653 IDDS identified, 62 were implanted primarily for CRPS-related pain. Of these, 26 had four or more years of complete follow-up data. Pain scores did not significantly decrease over time, and we observed no correlation between pain intensity and use of any intrathecal medication. Although oral opioid intake decreased over time, intrathecal opioid dose did not affect oral opioid consumption. Ziconotide was associated with a hastening of the decrease in oral opioid intake, whereas the presence of bupivacaine paradoxically increased oral opioid intake. Conclusions: Our study demonstrates that intrathecal opioid dose was not associated with long-term decreases in oral opioid intake. Additionally, ziconotide was associated with a decrease in oral opioid intake over the four-year follow-up, and bupivacaine was associated with an increase in oral opioid intake. Our study examines the long-term effectiveness of intrathecal medications in managing pain in patients with complex regional pain syndrome. We present a detailed follow-up over four years for 26 patients, tracking oral opiate intake, pain scores, and intrathecal pump settings. Our findings suggest that intrathecal opiates may not be effective in reducing oral opiate intake, ziconotide may hasten a decrease in intake, and bupivacaine may lead to an increase in intake. (© 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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