Analgesic Effectiveness of Intrathecal Pump Therapy for Chronic Pancreatitis: A Retrospective Analysis

Background: This retrospective study analyzeddata among a single-center cohort of patientsat a university hospital center designed as anInstitutional Review Board (IRB)-approved retrospectivechart review to assess the outcomesassociated with intrathecal pump (ITP) placementin patients with severe abdominal pain fromchronic pancreatitis.Objectives: Examine ITP therapy as an alternativeform of analgesia for chronic pancreatitis.Study Design: A retrospective analysis.Setting: The pain management department atthe University of Toledo.Methods: The primary outcomes assessed oralnarcotic requirement, visual analog scale (VAS)pain scores, and the number of hospital admissions,with the outcome assessments takenpre-ITP placement and 1, 6, 12, and 24 monthspost-ITP placement.Results: A total of 8 patients, with a mean age of44.6 years, who underwent ITP placement followingfailed conservative therapies for abdominalpain from chronic pancreatitis were reviewed. Areduction in pain level average (VAS) was notedfrom pre-ITP placement (VAS = 8.38, SD = 1.49)to post-ITP placement at 1 month (VAS = 4.85,SD = 2.20, P = 0.0127), 6 months (VAS = 4.43,SD = 2.50, P = 0.0134), 12 months (VAS = 3.67,SD = 2.36, P = 0.0112), and 24 months (VAS =4.8, SD = 2.63, P = 0.0459). A reduction in meanhospitalizations (MH) post-ITP was noted frompre-ITP placement (MH = 9.25, SD = 11.12) topost-placement at 1 month (MH = 0, SD = 0, P =0.0637), 6 months (MH = 0.125, SD = 0.33, P =0.1403), 12 months (MH = 0.167, SD = 0.37, P= 0.1502), and 24 months (MH = 0.2, SD = 0.4,P = 0.1457). A reduction in mean oral morphinesulfate equivalents (MEq) occurred from pre-ITPplacement (MEq = 293.98, SD = 302.99) to post-ITP placement at 1 month (MEq = 11.025, SD =19.35, P = 0.0369), 6 months (MEq = 14.4, SD= 19.55, P = 0.0578), 12 months (MEq = 19.95,SD = 24.24, P = 0.0542), and 24 months (MEq =17.64, SD = 29.38, P = 0.0896).Limitations: The small sample size and the retrospectivenature of this study prove to be 2 majorlimitations.Conclusions: Statistically significant improvementsin postoperative pain levels across all ofthe time intervals post-ITP, in addition to largegross reductions in MH and MEq, collectively yieldpromising results for ITP therapy as an alternativetreatment modality for chronic abdominal pain inpatients with chronic pancreatitis.Key words: Intrathecal pump, intrathecal therapy,chronic pancreatitis, abdominal pain, chronic pain,analgesic effectiveness