In a recent Ethics Forum [1], Drs. John Loeser and Tim Deer opined on a case study involving the question of whether a patient should be considered for the implantation of an intrathecal opioid pump. While Dr. Loeser, who has been a critic of intrathecal opioids, recommended against implantation, Dr. Deer surprised many readers by also questioning the prudence of implantation in this particular...

BACKGROUND Intrathecal ziconotide is used to manage severe chronic pain. Although ziconotide is approved by the US Food and Drug Administration for monotherapy, it is sometimes used in combination with other intrathecal drugs for the management of intractable pain conditions in clinical practice. OBJECTIVES Evaluate the safety and tolerability of ziconotide combination therapy. STUDY DESIGN...

objective: to assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. materials and methods: the prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. they divided into two groups. in the first group, intrathecal morphine was used to achieve anal...

Patients continue to suffer from pain despite their analgesic regimen and frequently from symptoms related to these interventions. This article describes the role that intrathecal analgesia may play in improving comfort for individuals experiencing refractory pain and/or symptoms of opioid therapy. Patient selection, staff education, institution requirements, medications, and titration guidelin...

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 Adm...

INTRODUCTION Studies have shown that, at low doses and with careful titration, combination therapy with intrathecal ziconotide and morphine results in rapid control of opioid-refractory cancer pain. However, there is a lack of published data regarding the efficacy and safety of intrathecal ziconotide specifically for the treatment of neuropathic cancer pain. CASE SERIES Case reports of zicono...

Among patients with chronic unrelieved pain, war veterans of eight years long Iraq - Iran war deserve especial attention. They not only suffer from severe intractable pain but also should bear some intangible consequences of unrelieved pain and severe disability. This perspective study reviews the outcome of implantation of intrathecal opioid pumps in these patients. Ten war veterans (mean age ...

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. Materials and Methods. A double blind, randomized, crossover, multicenter study was performed in 24 patients with intrathecal pumps. For four consecutive months, their pumps...

BACKGROUND Age and gender may exert important influences on opioid responsiveness and chronic pain. These effects have not been explored in the setting of chronic intrathecal (IT) opioid therapy. The objective of this study was to evaluate the effect of age and sex on IT opioid requirements during the first year after implantation of an intrathecal drug delivery system (IDDS) in chronic noncanc...

Background: Implantable pumps for intrathecal opioid therapy in the last decades emerged as one of the most effective treatment for chronic non-malignant pain (CNMP) in selected patients. This study analyses reliability of intrathecal infusion morphine therapy for chronic and refractory pain not related to malignancy using an implantable constant flow pump. Methods: we studied eleven patients (...