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Targeted Intrathecal Drug Delivery in Chronic Noncancer Pain: Best Practices

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Neuraxial Therapeutics

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Abstract

Unlike patients with cancer related pain, chronic noncancer pain (CNCP) patients’ survival is not limited by malignancy. As such, CNCP patients have extended time exposures to intrathecal drug delivery (IDD). While this allows for enhanced therapy optimization, it also predisposes CNCP patients to higher likelihood of complications related to intrathecal medications or the intrathecal drug delivery system. A number of clinical factors may influence response to IDD, including among others: patient demographics, pain location, and nature and the starting baseline opioid dosage. These factors would influence IDD patient selection, procedure performance, and medication choices as well as maintenance and optimization of the therapy. This chapter reviews salient characteristics that are important for optimizing targeted intrathecal drug delivery in chronic noncancer pain patients.

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References

  1. Onofrio BM, Yaksh TL, Arnold PG. Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc. 1981;56(8):516–20.

    PubMed  Google Scholar 

  2. Greenberg HS, Taren J, Ensminger WD, Doan K. Benefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain. J Neurosurg. 1982;57(3):360–4.

    Article  PubMed  Google Scholar 

  3. Penn RD, Paice JA, Gottschalk W, Ivankovich AD. Cancer pain relief using chronic morphine infusion. Early experience with a programmable implanted drug pump. J Neurosurg. 1984;61(2):302–6.

    Article  PubMed  Google Scholar 

  4. Wang JK. Intrathecal morphine for intractable pain secondary to cancer of pelvic organs. Pain. 1985;21(1):99–102.

    Article  PubMed  Google Scholar 

  5. Follett KA, Hitchon PW, Piper J, Kumar V, Clamon G, Jones MP. Response of intractable pain to continuous intrathecal morphine: a retrospective study. Pain. 1992;49(1):21–5.

    Article  PubMed  Google Scholar 

  6. Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg. 1996;85(3):458–67.

    Article  PubMed  Google Scholar 

  7. SynchroMed Product Performance Report 2013. https://asiapac.medtronic.com/content/dam/medtronic-com/products/product-performance/ppr-reports/product-performance-report-2013.pdf.

  8. SynchroMed Prodcut Performance Report 2018. https://www.medtronic.com/content/dam/medtronic-com/products/product-performance/ppr-reports/2018-TDD-Report.pdf.

  9. Angel IF, Gould HJ Jr, Carey ME. Intrathecal morphine pump as a treatment option in chronic pain of nonmalignant origin. Surg Neurol. 1998;49(1):92–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  10. North RB, Cutchis PN, Epstein JA, Long DM. Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. Neurosurgery. 1991;29(5):778–84.

    Article  PubMed  Google Scholar 

  11. Paice JA, Penn RD, Shott S. Intraspinal morphine for chronic pain: a retrospective, multicenter study. J Pain Symptom Manag. 1996;11(2):71–80.

    Article  Google Scholar 

  12. Rauck RL, Cherry D, Boyer MF, Kosek P, Dunn J, Alo K. Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. J Pain. 2003;4(8):441–7.

    Article  PubMed  Google Scholar 

  13. Smith TJ, Staats PS, Deer T, Stearns LJ, Rauck RL, Boortz-Marx RL, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.

    Article  PubMed  Google Scholar 

  14. Deer TR, Pope JE, Hayek SM, Bux A, Buchser E, Eldabe S, et al. The Polyanalgesic consensus conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation. 2017;20(2):96–132.

    Article  PubMed  Google Scholar 

  15. Hamza M, Doleys D, Wells M, Weisbein J, Hoff J, Martin M, et al. Prospective study of 3-year follow-up of low-dose intrathecal opioids in the management of chronic nonmalignant pain. Pain Med. 2012;13(10):1304–13.

    Article  PubMed  Google Scholar 

  16. Hayek SM, Veizi IE, Narouze SN, Mekhail N. Age-dependent intrathecal opioid escalation in chronic noncancer pain patients. Pain Med. 2011;12(8):1179–89.

    Article  PubMed  Google Scholar 

  17. Mekhail N, Mahboobi R, Farajzadeh Deroee A, Costandi S, Dalton J, Guirguis M, et al. Factors that might impact intrathecal drug delivery (IDD) dose escalation: a longitudinal study. Pain. 2014;14(4):301–8.

    Google Scholar 

  18. Veizi IE, Hayek SM, Narouze S, Pope JE, Mekhail N. Combination of intrathecal opioids with bupivacaine attenuates opioid dose escalation in chronic noncancer pain patients. Pain Med. 2011;12(10):1481–9.

    Article  PubMed  Google Scholar 

  19. De Conno F, Caraceni A, Martini C, Spoldi E, Salvetti M, Ventafridda V. Hyperalgesia and myoclonus with intrathecal infusion of high-dose morphine. Pain. 1991;47(3):337–9.

    Article  PubMed  Google Scholar 

  20. Singla A, Stojanovic MP, Chen L, Mao J. A differential diagnosis of hyperalgesia, toxicity, and withdrawal from intrathecal morphine infusion. Anesth Analg. 2007;105(6):1816–9. Table of contents.

    Article  PubMed  Google Scholar 

  21. Aldrete JA, Couto da Silva JM. Leg edema from intrathecal opiate infusions. Eur J Pain. 2000;4(4):361–5.

    Article  PubMed  Google Scholar 

  22. Veizi E, Tornero-Bold M, Hayek SM. Resolution of intrathecal hydromorphone or morphine-induced peripheral edema by opioid rotation to fentanyl: a case series. Pain Pract. 2016;16(6):E94–8.

    Article  PubMed  Google Scholar 

  23. Duarte RV, Raphael JH, Southall JL, Baker C, Ashford RL. Intrathecal granuloma formation as result of opioid delivery: systematic literature review of case reports and analysis against a control group. Clin Neurol Neurosurg. 2012;114(6):577–84.

    Article  PubMed  Google Scholar 

  24. Krames ES. Intraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines. J Pain Symptom Manag. 1996;11(6):333–52.

    Article  Google Scholar 

  25. Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection. Curr Opin Anaesthesiol. 2004;17(5):441–7.

    Article  PubMed  Google Scholar 

  26. Bernards CM. Cerebrospinal fluid and spinal cord distribution of baclofen and bupivacaine during slow intrathecal infusion in pigs. Anesthesiology. 2006;105(1):169–78.

    Article  PubMed  Google Scholar 

  27. Flack SH, Anderson CM, Bernards C. Morphine distribution in the spinal cord after chronic infusion in pigs. Anesth Analg. 2011;112(2):460–4.

    Article  PubMed  Google Scholar 

  28. Flack SH, Bernards CM. Cerebrospinal fluid and spinal cord distribution of hyperbaric bupivacaine and baclofen during slow intrathecal infusion in pigs. Anesthesiology. 2010;112(1):165–73.

    Article  PubMed  Google Scholar 

  29. Hassenbusch SJ, Stanton-Hicks M, Covington EC, Walsh JG, Guthrey DS. Long-term intraspinal infusions of opioids in the treatment of neuropathic pain. J Pain Symptom Manag. 1995;10(7):527–43.

    Article  Google Scholar 

  30. Kim D, Saidov A, Mandhare V, Shuster A. Role of pretrial systemic opioid requirements, intrathecal trial dose, and non-psychological factors as predictors of outcome for intrathecal pump therapy: one clinician's experience with lumbar postlaminectomy pain. Neuromodulation. 2011;14(2):165–75; discussion 75.

    Article  PubMed  Google Scholar 

  31. Kumar K, Kelly M, Pirlot T. Continuous intrathecal morphine treatment for chronic pain of nonmalignant etiology: long-term benefits and efficacy. Surg Neurol. 2001;55(2):79–86; discussion 8.

    Article  PubMed  Google Scholar 

  32. Grider JS, Etscheidt MA, Harned ME, Lee J, Smith B, Lamar C, et al. Trialing and maintenance dosing using a low-dose intrathecal opioid method for chronic nonmalignant pain: a prospective 36-month study. Neuromodulation. 2016;19(2):206–19.

    Article  PubMed  Google Scholar 

  33. Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–20.

    Article  PubMed  Google Scholar 

  34. van Hilten BJ, van de Beek WJ, Hoff JI, Voormolen JH, Delhaas EM. Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med. 2000;343(9):625–30.

    Article  PubMed  Google Scholar 

  35. van der Plas AA, van Rijn MA, Marinus J, Putter H, van Hilten JJ. Efficacy of intrathecal baclofen on different pain qualities in complex regional pain syndrome. Anesth Analg. 2013;116(1):211–5.

    Article  PubMed  Google Scholar 

  36. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the neuropathic pain scale. Neurology. 1997;48(2):332–8.

    Article  PubMed  Google Scholar 

  37. Kapural L, Lokey K, Leong MS, Fiekowsky S, Stanton-Hicks M, Sapienza-Crawford AJ, et al. Intrathecal ziconotide for complex regional pain syndrome: seven case reports. Pain Pract. 2009;9(4):296–303.

    Article  PubMed  Google Scholar 

  38. Hayek SM, Hanes MC, Wang C, Veizi IE. Ziconotide combination intrathecal therapy for noncancer pain is limited secondary to delayed adverse effects: a case series with a 24-month follow-up. Neuromodulation. 2015 Jul;18(5):397–403.

    Article  PubMed  Google Scholar 

  39. Brinzeu A, Berthiller J, Caillet JB, Staquet H, Mertens P. Ziconotide for spinal cord injury-related pain. Eur J Pain. 2019;23(9):1688–700.

    Article  PubMed  Google Scholar 

  40. Webster LR, Fisher R, Charapata S, Wallace MS. Long-term intrathecal ziconotide for chronic pain: an open-label study. J Pain Symptom Manag. 2009;37(3):363–72.

    Article  Google Scholar 

  41. Staats PS, Yearwood T, Charapata SG, Presley RW, Wallace MS, Byas-Smith M, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA. 2004;291(1):63–70.

    Article  PubMed  Google Scholar 

  42. Deer T, Rauck RL, Kim P, Saulino MF, Wallace M, Grigsby EJ, et al. Effectiveness and safety of intrathecal Ziconotide: interim analysis of the patient registry of intrathecal Ziconotide management (PRIZM). Pain Pract. 2018;18(2):230–8.

    Article  PubMed  Google Scholar 

  43. Deer TR, Prager J, Levy R, Rathmell J, Buchser E, Burton A, et al. Polyanalgesic consensus conference 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15(5):436–64; discussion 64–6.

    Article  PubMed  Google Scholar 

  44. Wang Y, Mitchell J, Moriyama K, Kim KJ, Sharma M, Xie GX, et al. Age-dependent morphine tolerance development in the rat. Anesth Analg. 2005;100(6):1733–9.

    Article  PubMed  Google Scholar 

  45. Buntin-Mushock C, Phillip L, Moriyama K, Palmer PP. Age-dependent opioid escalation in chronic pain patients. An Anesth Analg 2005;100(6):1740–1745.

    Google Scholar 

  46. Dominguez E, Sahinler B, Bassam D, Day M, Lou L, Racz G, et al. Predictive value of intrathecal narcotic trials for long-term therapy with implantable drug administration systems in chronic non-cancer pain patients. Pain Pract. 2002;2(4):315–25.

    Article  PubMed  Google Scholar 

  47. Grider JS, Harned ME, Etscheidt MA. Patient selection and outcomes using a low-dose intrathecal opioid trialing method for chronic nonmalignant pain. Pain Physician. 2011;14(4):343–51.

    Article  PubMed  Google Scholar 

  48. Duggan EW, Carlson K, Umpierrez GE. Perioperative hyperglycemia management: an update. Anesthesiology. 2017;126(3):547–60.

    Article  PubMed  Google Scholar 

  49. Hwang JU, Son DW, Kang KT, Lee SH, Lee JS, Song GS, et al. Importance of hemoglobin A1c levels for the detection of post-surgical infection following single-level lumbar posterior fusion in patients with diabetes. Korean J Neurotrauma. 2019;15(2):150–8.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Deer TR, Pope JE, Hayek SM, Lamer TJ, Veizi IE, Erdek M, et al. The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation.

    Google Scholar 

  51. Hayek SM. Intrathecal “microdosing”: reality or artifact? Pain Med. 2012;13(12):1664–5. author reply 6

    Article  PubMed  Google Scholar 

  52. Ade T, Roh J, Sharma G, Mohan M, DeLozier SJ, Janes JL, et al. Comparative effectiveness of targeted intrathecal drug delivery using a combination of bupivacaine with either low-dose fentanyl or hydromorphone in chronic back pain patients with lumbar postlaminectomy syndrome. Pain Med. 2020;21(9):1921–8.

    Article  PubMed  Google Scholar 

  53. Deer TR, Hayek SM, Pope JE, Lamer TJ, Hamza M, Grider JS, et al. The polyanalgesic consensus conference (PACC): recommendations for trialing of intrathecal drug delivery infusion therapy. Neuromodulation. 2017;20(2):133–54.

    Article  PubMed  Google Scholar 

  54. Kroin JS. Intrathecal drug administration. Present use and future trends. Clin Pharmacokinetics. 1992;22(5):319–26.

    Article  Google Scholar 

  55. Hayek SM, Joseph PN, Mekhail NA. Pharmacology of intrathecally administered agents for treatment of spasticity and pain. Sem Pain Med. 2003;1(4):238–53.

    Article  Google Scholar 

  56. Hayek SM, Paige B, Girgis G, Kapural L, Fattouh M, Xu M, et al. Tunneled epidural catheter infections in noncancer pain: increased risk in patients with neuropathic pain/complex regional pain syndrome. Clin J Pain. 2006;22(1):82–9.

    Article  PubMed  Google Scholar 

  57. Ver Donck A, Vranken JH, Puylaert M, Hayek S, Mekhail N, Van Zundert J. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461–76.

    Article  Google Scholar 

  58. Allen JW, Horais KA, Tozier NA, Wegner K, Corbeil JA, Mattrey RF, et al. Time course and role of morphine dose and concentration in intrathecal granuloma formation in dogs: a combined magnetic resonance imaging and histopathology investigation. Anesthesiology. 2006;105(3):581–9.

    Article  PubMed  Google Scholar 

  59. Deer TR, Prager J, Levy R, Rathmell J, Buchser E, Burton A, et al. Polyanalgesic Consensus Conference—2012: consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). Neuromodulation 2012;15(5):483–495; discussion 96.

    Google Scholar 

  60. Weaver T, Wells M, Roediger M, Stromberg K. Medtronic 2013 product performance report; 2013, pp. 1–151. https://wwwmedtroniccom/wcm/groups/mdtcom_sg/@mdt/@corp/documents/documents/annual_report_2013pdf.

    Google Scholar 

  61. Hassenbusch SJ, Portenoy RK. Current practices in intraspinal therapy—a survey of clinical trends and decision making. J Pain Symptom Manag. 2000;20(2):S4–11.

    Article  Google Scholar 

  62. Staats P, Whitworth M, Barakat M, Anderson W, Lilienfeld S. The use of implanted programmable infusion pumps in the management of nonmalignant, chronic low-back pain. Neuromodulation. 2007;10(4):376–80.

    Article  PubMed  Google Scholar 

  63. Mironer YE, Haasis JC, Chapple I, Brown C, Satterthwaite JR. Efficacy and safety of intrathecal opioid/bupivacaine mixture in chronic nonmalignant pain: a double blind, randomized, crossover, multicenter study by the National Forum of independent pain clinicians (NFIPC). Neuromodulation. 2002;5(4):208–13.

    Article  PubMed  Google Scholar 

  64. Deer TR, Caraway DL, Kim CK, Dempsey CD, Stewart CD, McNeil KF. Clinical experience with intrathecal bupivacaine in combination with opioid for the treatment of chronic pain related to failed back surgery syndrome and metastatic cancer pain of the spine. Spine J. 2002;2(4):274–8.

    Article  PubMed  Google Scholar 

  65. Hayek SM, Veizi E, Hanes M. Intrathecal hydromorphone and bupivacaine combination therapy for post-laminectomy syndrome optimized with patient-activated bolus device. Pain Med. 2016 Mar;17(3):561–71.

    PubMed  Google Scholar 

  66. Galica RJ, Hayek SM, Veizi E, McEwan MT, Katta S, Ali O, et al. Intrathecal trialing of continuous infusion combination therapy with hydromorphone and bupivacaine in failed back surgery patients. Neuromodulation. 2018;21(7):648–54.

    Article  PubMed  Google Scholar 

  67. Veizi IE, Hayek SM, Hanes M, Galica R, Katta S, Yaksh T. Primary hydromorphone-related intrathecal catheter tip granulomas: is there a role for dose and concentration? Neuromodulation. 2016;19(7):760–9.

    Article  PubMed  Google Scholar 

  68. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92(3):739–53.

    Article  PubMed  Google Scholar 

  69. Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology. 1998;88(2):355–61.

    Article  PubMed  Google Scholar 

  70. Southwell DG, Osorio JA, Liverman CS, Friedman LM, Naidu RK, Poree LR, et al. Intrathecal catheter-associated inflammatory mass in a neurofibromatosis type-1 patient receiving fentanyl and bupivacaine. Surg Neurol Int. 2017;8:159.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Zacest AC, Carlson JD, Nemecek A, Burchiel KJ. Surgical management of spinal catheter granulomas: operative nuances and review of the surgical literature. Neurosurgery. 2009;65(6):1161–4; discussion 4–5.

    Article  PubMed  Google Scholar 

  72. Ngan Kee WD, Khaw KS, Ng FF, Ng KK, So R, Lee A. Synergistic interaction between fentanyl and bupivacaine given intrathecally for labor analgesia. Anesthesiology. 2014;120(5):1126–36.

    Article  PubMed  Google Scholar 

  73. Parpaglioni R, Baldassini B, Barbati G, Celleno D. Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required. Acta Anaesthesiol Scand. 2009;53(9):1214–20.

    Article  PubMed  Google Scholar 

  74. Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology. 1992;77(6):1186–2000.

    Article  PubMed  Google Scholar 

  75. Gilron I, Chaparro LE, Tu D, Holden RR, Milev R, Towheed T, et al. Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. Pain. 2016;157(7):1532–40.

    Article  PubMed  Google Scholar 

  76. Gilron I, Orr E, Tu D, O'Neill JP, Zamora JE, Bell AC. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain. 2005;113(1–2):191–200.

    Article  PubMed  Google Scholar 

  77. Hayek SM, McEwan MT, Veizi E, DeLozier SJ, Pogrebetskaya M. Effects of bupivacaine on opioid patient-controlled intrathecal analgesia in chronic pain patients implanted with drug delivery systems. Pain Med. 2021;22(1):22–33.

    Article  PubMed  Google Scholar 

  78. Reif I, Wincent A, Stiller CO. Intrathecal analgesia by bupivacaine is not enhanced by coadministration of morphine in patients with severe cancer-related pain: a randomized double-blind cross-over study. Int J Clin Pharmacol Therapeut. 2017;55(6):525–32.

    Article  Google Scholar 

  79. Galica R, Hayek SM, Veizi IE, Lawrence MM, Khalil AA, McEwan MT. Sudden intrathecal drug delivery device motor stalls: a case series. Reg Anesth Pain Med. 2016;41(2):135–9.

    Article  PubMed  Google Scholar 

  80. McEwan MT, Hayek SM, Galica R, Sundaram V, Veizi E. Sudden intrathecal drug delivery device motor stalls: a case series update. Reg Anesth Pain Med. 2018;43(6):654–5.

    Article  PubMed  Google Scholar 

  81. Delhaas EM, Harhangi BS, Frankema SPG, Huygen F, van der Lugt A. Catheter access port (computed tomography) myelography in intrathecal drug delivery troubleshooting: a case series of 70 procedures. Neuromodulation. 2020;23(7):949–60.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Stinchon JF, Shah NP, Ordia J, Oates E. Scintigraphic evaluation of intrathecal infusion systems: selection of patients for surgical or medical management. Clin Nucl Med. 2006;31(1):1–4.

    Article  PubMed  Google Scholar 

  83. Ellis JA, Leung R, Winfree CJ. Spinal infusion pump-catheter leak detected by high-resolution 3D computed tomography. J Neurosurg Spine. 2011;15(5):555–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Salim Michel Hayek

  2. Department of Anesthesiology, Case Western Reserve University, Cleveland, OH, USA

    Salim Michel Hayek

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  1. (CTF-312), UC San Diego-Anesthesia Res Lab 081 (CTF-312), La Jolla, CA, USA

    Tony Yaksh

  2. University Hospital, Case Western Reserve University, Cleveland, OH, USA

    Salim Hayek

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Hayek, S.M. (2023). Targeted Intrathecal Drug Delivery in Chronic Noncancer Pain: Best Practices. In: Yaksh, T., Hayek, S. (eds) Neuraxial Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-031-39558-1_32

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