Intrathecal opioid pump [Neurosurgery Wiki]

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====== Intrathecal opioid pump ======

[[Implantable pump]]s for the delivery of intrathecal [[morphine]] have become a common option for administering opiate medication for the management of pain in patients with terminal cancer. 

[[Intrathecal]] (IT) [[opiod pump]]s are one therapeutic cornerstone of refractory [[non malignant pain syndrome]]s. The aim of a study of Sommer et al., was to evaluate efficacy, surgical and pharmacological complications of [[intrathecal pump]]s beyond a time span of 10 years.

In this retrospective single-center cohort study, 27 patients (14 female, 13 male, age 64.0 ± 8.9 (median, 1 SD) yrs) were identified. Pain intensity using the numerical rating scale ([[NRS]]), pain and IT pump characteristics, and complications were analyzed. The [[German Pain Questionaire]] was used to investigate the physical and mental health status.

Overall time of IT therapy from first implantation to last follow-up was 20.4 ± 6.0 yrs. Time to implantation of the second pump (n=18) was 10.0 ± 5.3 yrs, between the second and third pump (n=6) 6.5 ± 2.7 yrs, and two patients received their 4th pump six years later. Before implantation, NRS was 9.0 ± 0.9, one year after implantation 7.0 ± 1.8 and 4.0 ± 2.3 at the last follow-up. IT drug dose remained stable after 3 years. Opioid intoxications occurred in three patients (10%). One patient (3%) underwent revision surgery due to a catheter infection. Drug side effects occurred in 4 patients (14%). Our patient group has pain-related restrictions in physical activities with menial impact regarding mental and emotional stress.

Even after a time span of over 15 years and several exchanges of pump systems, pain intensity is still reduced. After 3 years, IT drug dose remained unchanged with low side-effects and complication rates
((Sommer B, Karageorgos N, AlSharif M, Stubbe H, Hans FJ. Long-term outcome and 
adverse events of intrathecal opiod therapy for non-malignant pain syndrome. Pain
Pract. 2019 Jul 10. doi: 10.1111/papr.12818. [Epub ahead of print] PubMed PMID:
31291509.
)).