Ceasing Intrathecal Therapy in Chronic Non-Cancer Pain An Invitation to Shift from Biomedical Focus to Active Management 英文参考文献.docVIP

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Ceasing Intrathecal Therapy in Chronic Non-Cancer Pain An Invitation to Shift from Biomedical Focus to Active Management 英文参考文献.doc

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Ceasing Intrathecal Therapy in Chronic Non-Cancer Pain An Invitation to Shift from Biomedical Focus to Active Management 英文参考文献

CeasingIntrathecalTherapyinChronicNon-CancerPain: AnInvitationtoShiftfromBiomedicalFocustoActive Management ChrisHayes*,MeredithS.Jordan,FionaJ.Hodson,LindaRitchard HunterIntegratedPainService,Newcastle,NewSouthWales,Australia Abstract Objective:Toreportlongtermexperience(1997–2009)ofintrathecal(IT)therapyforchronicnon-cancerpaininthecontext ofourteam’sincreasingemphasisonactivemanagement. Design:Descriptivecaseseries. Setting:Australiantertiarymultidisciplinarypaincenter,HunterIntegratedPainService(HIPS). Intervention:ThiscaseseriesreportsthechanginguseofITimplanteddrugdeliverysystems(IDDSs)forchronicnon-cancer painover13years.InitiallyITtherapywasusedselectivelyfollowingmultidisciplinaryassessmentanddoubleblindITtrial. Typicaltherapycombinedopioidwithclonidine.Multidimensionalmanagementwasoffered.Treatmentstrategychanged in 2003 due to HIPS experience of limited therapeutic gains and equivocal support for IT therapy in the literature. SubsequentlyITtherapywasnolongerinitiatedfornon-cancerpainandthoseonestablishedregimeswereencouragedto shifttooral/transdermalopioidswithgreateremphasisonactivemanagement.Patienteducationandconsultationwere keyelements.WhereITcessationwaselectivegradualdosereductioncommencedasanoutpatient.Inelectiveandurgent casesketamineinfusionandoralclonidinewereusedduringhospitaladmissionstocovertheswitchtooral/transdermal opioids.Overthestudyperiodtransitionoccurredtoabroader managementframework inwhichITtherapyforchronic non-cancerpainwasnolongersupportedbyHIPS. Results:25patientsweremanagedusingIDDSs;8implantedbyHIPSand17byotherteams.Doseescalationandadverse effects were common. 24 of 25 patients ceased IT therapy; 7 (29%) with urgent IDDS related complications, 16 (67%) electivelyand1duetoanunrelateddeath.TheremainingpatientreturnedtoheroriginalteamtocontinueITtherapy.One post-explantation patient transferred to another team to recommence IT therapy. The remainder were successfully maintainedonoral/transdermalopioidscombinedwithactivem