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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2002

Open Access 01-12-2002 | Research article

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain

Authors: JH Raphael, JL Southall, TV Gnanadurai, GJ Treharne, GD Kitas

Published in: BMC Musculoskeletal Disorders | Issue 1/2002

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Abstract

Background

Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery.

Methods

We have investigated spinal drug administration systems for patients with failed back syndrome and chronic mechanical low back pain by patient questionnaire study of the efficacy of this therapy and a case notes review.

Results

36 patients (97% of 37 approached) completed questionnaires, 24 with failed back syndrome and 12 with chronic mechanical low back pain. Recalled pre-treatment levels with current post-treatment levels of pain and a range of quality of life measures (recorded on 11-point numerical rating scales) were compared. Pain improved significantly in both groups (Wilcoxan signed ranks test, p < 0.005). The majority of quality of life measures improved significantly in the failed back syndrome group (Wilcoxan signed ranks test, p < 0.005) although work interruption and the effect of pain on sex life did not change. There was a trend towards improvement in the majority of quality of life measures in the mechanical back pain group but this did not reach statistical significance due to the smaller numbers in this cohort (p > 0.005, Wilcoxan signed ranks test with Bonferroni correction).
Diamorphine was used in all 37 patients, bupivacaine in 32, clonidine in 27 and baclofen in 3. The mean dose of diamorphine increased for the first 2 years but did not change 2–6 years post implant, averaging 4.5 mg/day. Revision surgery was required in 24% of cases, but reduced to 12% in the later years of our experience.

Conclusions

We conclude that spinal drug administration systems appear to be of benefit in alleviating pain in the failed back syndrome and chronic mechanical low back pain but need to be examined prospectively.
Literature
1.
Clinical Standards Advisory Group on Back Pain. HMSO. 1994
2.
Krames ES: Intraspinal opioid therapy for chronic non-malignant pain: current practice and clinical guidelines. J Pain Symptom Manage. 1996, 11: 333-52. 10.1016/0885-3924(96)00010-3.CrossRefPubMed
3.
Wang JK, Nauss LA, Thomas JE: Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979, 50: 149-51.CrossRefPubMed
4.
Lissovoy G, Brown RE, Halpern M, Hassenbusch SJ, Ross E: Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome. Clinical Therapeutics. 1997, 19 (1): 96-112. 10.1016/S0149-2918(97)80077-X.CrossRefPubMed
5.
Paice JA, Penn RD, Shott S: Intraspinal morphine for chronic pain: a retrospective multicenter study. J Pain Symptom Manage. 1996, 11: 71-80. 10.1016/0885-3924(95)00099-2.CrossRefPubMed
6.
Winkelmuller M, Winkelmuller W: Long-term effects of continuous intrathecal opioid treatment in chronic pain of non-malignant etiology. J Neurosurg. 1996, 85: 458-67.CrossRefPubMed
7.
Anderson VC, Burchiel KJ: A prospective study of long term intrathecal morphine in the management of chronic non-malignant pain. Neurosurgery. 1999, 44: 289-300.CrossRefPubMed
8.
Jensen MP, Karoly P, Braver S: The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986, 27: 117-26. 10.1016/0304-3959(86)90228-9.CrossRefPubMed
9.
Jensen MP, Karoly P, Harris P: Assessing the affective component of chronic pain: development of the Pain Discomfort Scale. J Psychosom Res. 1991, 35: 149-54. 10.1016/0022-3999(91)90069-Z.CrossRefPubMed
10.
Zenz M, Strumpf M, Tryba M: Long term oral opioid therapy in patients with chronic nonmalignant pain. J Pain Symptom Manage. 1992, 7: 69-77.CrossRefPubMed
11.
Jadad AR, Carroll D, Glynn CJ, Moore RA, McQuay HJ: Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia. Lancet. 1992, 339: 1367-71. 10.1016/0140-6736(92)91194-D.CrossRefPubMed
12.
Suzuki R, Chapman V, Dickenson AH: The effectiveness of spinal and systemic morphine on rat dorsal horn neuronal responses in the spinal nerve ligation model of neuropathic pain. Pain. 1999, 80: 215-28. 10.1016/S0304-3959(98)00208-5.CrossRefPubMed
13.
Tutak U, Doleys DM: Intrathecal infusion systems for treatment of chronic low back pain of non-cancer origin. South Med J. 1996, 89: 295-300.CrossRefPubMed
14.
Follett KA, Naumann CP: A prospective study of catheter-related complications of intrathecal drug delivery systems. J Pain Symptom Manage. 2000, 19: 209-15. 10.1016/S0885-3924(99)00153-0.CrossRefPubMed
15.
Bolton JE: Accuracy of recall of usual pain intensity in back pain patients. Pain. 1999, 83: 533-9. 10.1016/S0304-3959(99)00161-X.CrossRefPubMed
16.
Linton SJ, Gotestam KG: A clinical comparison of two pain scales: correlation, remembering chronic pain, and a measure of compliance. Pain. 1983, 17: 57-65. 10.1016/0304-3959(83)90127-6.CrossRefPubMed
17.
Edwards L, Pearce S, Collett BJ, Pugh R: Selective memory for sensory and affective information in chronic pain and depression. Br J Clin Psychol. 1992, 31: 239-48.CrossRefPubMed
18.
Erskine A, Morley S, Pearce S: Memory for pain: a review. Pain. 1990, 41: 255-65. 10.1016/0304-3959(90)90002-U.CrossRefPubMed
19.
Bryant RA: Memory for pain and affect in chronic pain patients. Pain. 1993, 54: 347-51. 10.1016/0304-3959(93)90036-O.CrossRefPubMed
20.
Hill RG, Salt TE, Pepper CM: A comparison of the effectiveness of intravenous morphine at attenuating the nociceptive responses of medullary dorsal horn and thalamic neurones. Life Sci. 1982, 31: 2331-34. 10.1016/0024-3205(82)90149-7.CrossRefPubMed
Metadata
Title
Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain
Authors
JH Raphael
JL Southall
TV Gnanadurai
GJ Treharne
GD Kitas
Publication date
01-12-2002
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2002
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-3-17

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