UI - 000150

AU - Krames ES

TI - Intrathecal infusional therapies for intractable pain: patient management guidelines

AB - This article focuses on appropriate patient selection for and management of patients selected for

continuous spinal infusional opioid therapy. Patients with cancer-related pain who have undergone sequential

strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone a

successful spinal opioid efficacy trial are candidates for implantable spinal infusional therapy. Patients with

noncancer-related chronic pain, who have failed all conventional syndrome-specific therapies before

neuroablative surgical procedures, including sequential strong opioid drug trials, who have

intractable, unmanageable side effects, and who have undergone successful spinal opioid efficacy trial

are deemed candidates for implantable spinal infusional therapy. Patients with chronic noncancer-

related pain and patient with cancer-related pain who have life expectancies greater than 3 mo all have

implanted programmable infusion pumps. Patients with cancer-related pain who have life expectancies less

than 3 mo have implanted permanent epidural catheters connected to external pump systems. Management

guidelines for complications of therapy broadly categorized as surgical, mechanical, and pharmacologic are

presented.

SO - Journal of Pain & Symptom Management 1993;8:36-4