Presented at the 2012 AAPM Annual Meeting « Back

Low-Dose Intrathecal Opioid Trialing for Chronic Nonmalignant Pain: A Prospective Observation Cohort Study

Jay S. Grider, PhD DO, jsgrid2@email.uky.edu, University of Kentucky, Lexington, Kentucky

Introduction: We have recently described a method of trialing candidates for intrathecal therapy using a low-dose opioid method. (1 The current study reports VAS and dosage data for thirteen subjects prospectively followed in an observational cohort. Methods: This review was conducted under IRB approval as an ongoing observational cohort of 11 consecutive patients age 42–61 trialed, implanted, and maintained on a low-dose intrathecal morphine protocol provided by an implanted intrathecal drug delivery system. These 13 subjects were trialed and implanted using a previously described technique and pain scores were evaluated 6 months following implantation prospectively. Visual analog pain scores (VAS) and intrathecal opioid doses were recorded at implant and at 6 months. Results: The average daily dose of intrathecal morphine at trial and implantation 211 mcg/day. At 6 months the average daily dose of intrathecal morphine was 260 mcg/day. All subjects rated ongoing analgesia as acceptable with an average VAS of 2.7 +/- SE 0.2 (range 0-8) at 6 months follow-up. The subject reporting pain scores of 8/10 reported satisfaction with analgesia provided by intrathecal opioids at the current dose when compared to efficacy previously with oral opioids. Discussion: The current prospective observational cohort results are similar to those we retrospectively reported previously. The average VAS from the time of implant to 6 months follow-up was stable and all subjects reported that analgesia was acceptable at low doses of intrathecal morphine. References: 1)1) Grider JS, Harned ME and Etscheidt MA. Patient Selection and Outcomes Using a Low-Dose Intrathecal Opioid Trialing Method for Chronic Nonmalignant Pain. Pain Physician 14:343-351, 2011.

Funding: None