Efficacy and Safety of Intrathecal Opioid/Bupivacaine Mixture in Chronic Nonmalignant Pain: A Double Blind, Randomized, Crossover, Multicenter Study by the National Forum of Independent Pain Clinicians (NFIPC)

@article{Mironer2002EfficacyAS,
  title={Efficacy and Safety of Intrathecal Opioid/Bupivacaine Mixture in Chronic Nonmalignant Pain: A Double Blind, Randomized, Crossover, Multicenter Study by the National Forum of Independent Pain Clinicians (NFIPC)},
  author={Y. Eugene Mironer and John C Haasis and I. T. Chapple and Christopher K. Brown and John R. Satterthwaite},
  journal={Neuromodulation: Technology at the Neural Interface},
  year={2002},
  volume={5}
}
Objective. Intrathecal opioid/local anesthetic mixtures are a popular alternative in contemporary treatment of chronic nonmalignant pain. Unfortunately, its use is based solely on retrospective studies or anecdotal reports. 
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When minimally invasive interventional pain management techniques also fail to provide satisfactory pain relief, continuous intrathecal analgesic administration may be considered.
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Introduction:  The use of intrathecal (IT) infusion of analgesic medications to treat patients with chronic refractory pain has increased since its inception in the 1980s, and the need for clinical…
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This chapter is using IDDSs for chronic noncancer pain originating from the spine for patients who have failed previous conservative measures or have intolerable side effects with oral or transdermal medications.
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The addition of intrathecal bupivacaine restores pain control, improves activity level, quality of life, and mental health in this patient group and shows statistical improvement in six of eight domains.
Continuous Morphine Infusion: A Retrospective Study of Efficacy, Safety, and Demographic Variables
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    Neuromodulation : journal of the International Neuromodulation Society
  • 2009
TLDR
A number of different variables were assessed to analyze their effect on therapy and to determine in which patients intrathecal infusion is more effective.
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TLDR
The addition of small, presumably negligible bolus doses on top of the continuous infusion resulted in spectacular pain control, clear thermoanalgesic suspended block, and in one of the patients, significant hypotension.
Polyanalgesic Consensus Conference—2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain
  • T. Deer, R. Levy, +27 authors N. Mekhail
  • Biology, Medicine
    Neuromodulation : journal of the International Neuromodulation Society
  • 2012
TLDR
Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail, but it has become clear in recent years that intratheCal drug delivery is associated with risks for serious morbidity and mortality.
Intrathecal opioid therapy for chronic nonmalignant pain: a retrospective cohort study with 3-year follow-up.
TLDR
It is concluded that intratheCal opioids without adjunctive intrathecal medications have a favorable outcome, and results seem stable for prolonged periods, although some increase in intrathe cal opioids dosing may be required.
Combination of intrathecal opioids with bupivacaine attenuates opioid dose escalation in chronic noncancer pain patients.
TLDR
Concomitant initial coadministration of IT bupivacaine with opioids blunts the rate of IT opioid dose escalation during the first year after implantation of an IT drug delivery system (IDDS).
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