BACKGROUND: Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. METHODS: We used data pre- and postpump from 46 cancer patients receiving systemic opioids undergoing intrathecal pump placement in the last 6 years, all of whom had undergone an epidural trial before pump placement. RESULTS: By analyzing intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancer patients, an appropriate initial dose for an intrathecal pump based on the prepump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible. CONCLUSIONS: When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.
BACKGROUND:Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. METHODS: We used data pre- and postpump from 46 cancerpatients receiving systemic opioids undergoing intrathecal pump placement in the last 6 years, all of whom had undergone an epidural trial before pump placement. RESULTS: By analyzing intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancerpatients, an appropriate initial dose for an intrathecal pump based on the prepump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible. CONCLUSIONS: When an epidural trial is not feasible and an intrathecal pump is required in a cancerpatient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.
Authors: T J Smith; P J Coyne; P S Staats; T Deer; L J Stearns; R L Rauck; R L Boortz-Marx; E Buchser; E Català; D A Bryce; M Cousins; G E Pool Journal: Ann Oncol Date: 2005-04-07 Impact factor: 32.976
Authors: Timothy R Deer; Howard S Smith; Allen W Burton; Jason E Pope; Daniel M Doleys; Robert M Levy; Peter S Staats; Mark S Wallace; Lynn R Webster; Richard L Rauck; Michael Cousins Journal: Pain Physician Date: 2011 May-Jun Impact factor: 4.965
Authors: Thomas J Smith; Peter S Staats; Timothy Deer; Lisa J Stearns; Richard L Rauck; Richard L Boortz-Marx; Eric Buchser; Elena Català; David A Bryce; Patrick J Coyne; George E Pool Journal: J Clin Oncol Date: 2002-10-01 Impact factor: 44.544
Authors: D P Kelsen; R K Portenoy; H T Thaler; D Niedzwiecki; S D Passik; Y Tao; W Banks; M F Brennan; K M Foley Journal: J Clin Oncol Date: 1995-03 Impact factor: 44.544
Authors: Vivek T Malhotra; Paul Glare; Kay See Tan; Jonathan Wills; Amit Gulati; Vinay Puttanniah; Joseph Hung; Ken Cubert; Charles Inturrisi Journal: Pain Med Date: 2017-12-01 Impact factor: 3.750