Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm.
Intrathecal drug delivery is an effective treatment option for patients with severe chronic pain who have not obtained adequate analgesia from more conservative therapies (eg, physical therapy, systemic opioids, nonsteroidal anti-inflammatory drugs, antidepressants, and anticonvulsants). This review...
| Published in: | Pain Practice Vol. 16; no. 8; pp. 1092 - 1107 |
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| Main Authors: | , , , |
| Format: | algorithm case study review tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Nov2016
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119279830&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 119279830 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15307085 HYN jtl: Pain Practice issn: 15307085 maglogo: Y pubinfo: dt: Nov2016 vid: 16 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 119279830 119279830 119279830 10.1111/papr.12438 119279830 ppf: 1092 ppct: 15 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm. aug: au: Pope, Jason E. Deer, Timothy R. Bruel, Brian M. Falowski, Steven affil: Summit Pain Alliance, Santa Rosa California, U.S.A. sug: subj: Baclofen Administration and Dosage Pain Therapy Chronic Pain Cancer Pain Therapy Pain Adverse Health Care Event ab: Intrathecal drug delivery is an effective treatment option for patients with severe chronic pain who have not obtained adequate analgesia from more conservative therapies (eg, physical therapy, systemic opioids, nonsteroidal anti-inflammatory drugs, antidepressants, and anticonvulsants). This review focuses on, but is not limited to, the 2 agents currently approved by the U.S. Food and Drug Administration for intrathecal analgesia: preservative-free morphine and ziconotide (a nonopioid, selective N-type calcium channel blocker). We describe the appropriate use of intrathecal therapy in the management of severe chronic pain, based on current best practices. Topics addressed here include patient selection, trialing, dosing and titration, adverse event profiles, long-term management, intrathecal therapy for cancer-related pain, and the placement of intrathecal therapy in the pain care algorithm. In appropriately selected patients with chronic pain, intrathecal therapy can provide substantial pain relief with improved functioning and quality of life. Successful long-term management requires ongoing patient monitoring for changes in efficacy and the occurrence of adverse events, with subsequent changes in intrathecal dosing and titration, the addition of adjuvant intrathecal agents, and the use of concomitant oral medications to address side effects, as needed. Based on an infrequent but clinically concerning risk of overdose, granuloma, and other opioid-induced complications, nonopioid therapy with ziconotide may be preferred as a first-line intrathecal therapy in patients without a history of psychosis or allergy. pubtype: Academic Journal doctype: algorithm case study review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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