Open AccessIntrathecal Opioids for Chronic Pain: A Call for Evidence
Author(s) -
Harden R. Norman,
Argoff Charles E.,
Williams David A.
Publication year - 2012
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2012.01456.x
Subject(s) - medicine , intrathecal , chronic pain , pain medicine , anesthesia , opioid , medline , intensive care medicine , physical therapy , anesthesiology , receptor , political science , law
The first implanted fixed rate pumps were used in humans in the mid 1980s [1]. In 1991 Medtronic® released the first programmable pump for human use [2]. The majority of the research and reports concern programmable pumps, and the best and most current systematic review of the literature only identified manuscripts on these devices, and only considered chronic non-malignant pain (AKA chronic non cancer painCNCP) [1]. Older reviews are available [3–5]. No review, nor our literature search, identified a Randomized Controlled Trial (RCT) of implantable pumps using opioids in CNCP; yet despite such lack of evidence, the devices are commonly used for patients with CNCP. In contrast, there is an FDA drug registry of RCTs available for implantable pumps using ziconotide in CNCP [6]; IntraThecal (IT) baclofen has been assessed for spasticity (but no RCT: see Taricco et al [7].) and in the management of the dystonia of Complex Regional Pain Syndrome [8]. There is a good RCT of implantable pumps using opioids in cancer pain showing modest efficacy but substantial risk [9].