Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications

Abstract

Objectives 

We conducted a systematic review of the literature on the effectiveness and complications of programmable intrathecal opioid and ziconotide drug delivery systems (IDDS) for patients with chronic noncancer pain.

Methods 

We searched MEDLINE, Cochrane, and other bibliographic databases to identify English-language journal articles reporting programmable IDDS complications or effects on pain or functioning. Additional study methodology criteria were applied for the effectiveness review. Two authors independently abstracted data from each included article.

Results 

Six articles met the inclusion criteria for the effectiveness and complications reviews, and 4 others met the criteria only for the complications review; none were randomized trials or of ziconotide. All 6 articles reviewed for effectiveness reported improvement in pain and functioning on average among patients who received a permanent IDDS. Two articles reported the proportion of patients with ≥50% improvement in pain at 6 months (38%, 56%) and 2 at longer follow-ups (30%, 44%). Intrathecal morphine-equivalent doses increased over time. The most commonly reported permanent IDDS drug side effects were nausea/vomiting (mean rate weighted by sample size=33%), urinary retention (24%), and pruritus (26%). Catheter problems were also reported commonly. Rare but serious complications included intrathecal catheter tip granulomas.

Conclusions 

The studies reviewed found improvement in pain and functioning on average among patients with chronic noncancer pain who received permanent IDDS. However, their methodologic limitations preclude conclusions concerning the effectiveness of this technology long-term and as compared with other treatments. Drug side effects and hardware complications were common. Suggestions are made for methodologic improvements in future studies.