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Long-term Efficacy of Continuous Intrathecal Opioid Treatment for Malignant and Nonmalignant Pain

Leibrock, Lyal G.; Thorell, William E.; Tomes, Dan J.; Keber, Terri L.

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Continuous intrathecal opioid administration via an implantable pump is an effective method of treatment for chronic pain. This retrospective study examines the long-term effectiveness of continuous intrathecal opioid treatment in patients with malignant and nonmalignant chronic pain syndromes. We reviewed charts from 81 patients with a history of permanent pump implantation between 1989 and 2000 for treatment of chronic pain due to malignant or nonmalignant causes. We conducted follow-up using telephone interviews. Of the 81 patients, 31 had placement of the pump for malignant pain and 50 had placement for nonmalignant pain. Of those with malignant pain, 30 were no longer living at the time of the study. We were unable to locate 21 of those with nonmalignant pain. Of the 30 patients who participated in the study, 24 patients continued to use the pump, and six patients had the pump removed. Follow-up ranged from 2.2 years to 7.3 years, with an average follow-up of 4.5 years. Patient age ranged from 42 years to 84 years with an average age of 64 years. Twenty-two of the 24 patients still using the pump considered it effective at relieving their pain, with an average pain relief of 62.92% ± 16.81%. Eighteen of the 24 patients required oral pain medications for breakthrough pain. All patients had had their intrathecal opioid dose increased since the original time of pump placement. Complications occurred in eight patients, including eight fractured catheters, two coiled catheters, one displaced catheter, three pump malfunctions, two displaced pumps, and two infections, one of which was meningitis. Nine pumps were replaced due to battery depletion. Eighteen of the 24 patients reported no side effects. Those reporting adverse effects named constipation, urinary retention, nausea, anorexia, light-headedness, fatigue, increased hunger, facial flushing, dry mouth, pruritus, and edema as their complaints. This study, along with previous studies of long-term continuous intrathecal opioid administration, demonstrate that it is an effective treatment modality for chronic pain of both malignant and nonmalignant origin.

University of Nebraska Medical Center, Section of Neurosurgery, Department of Neurosurgery, Omaha, Nebraska

Address reprint requests and correspondence to: Dr. Dan J. Tomes, University of Nebraska Medical Center, Section of Neurosurgery, Department of Neurosurgery, 982035 Nebraska Medical Center, Omaha, NE 68198-2035. E-mail: djtomes@unmc.edu

Informed consent was obtained from the subjects after the nature and possible consequences of this study were explained to the subjects.

© 2002 Lippincott Williams & Wilkins, Inc.