TY - JOUR
T1 - Intrathecal therapy for cancer and nonmalignant pain
T2 - Patient selection and patient management
AU - Deer, Timothy
AU - Winkelmuller, Wolfhard
AU - Erdine, Serdar
AU - Bedder, Marshall
AU - Burchiel, Kim
N1 - Copyright:
Copyright 2004 Elsevier Science B.V., Amsterdam. All rights reserved.
PY - 1999
Y1 - 1999
N2 - Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the 'gold standard,' and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes. Patient selection criteria for cancer and nonmalignant pain are similar; however, a more comprehensive psychological and social assessment is required for patients with nonmalignant pain. In addition, all patients (those with cancer or nonmalignant pain) must exhibit a positive response to an epidural or intrathecal screening test. A multidisciplinary team approach, involving psychologists, nurses, physical therapists, social workers, and spiritual leaders should be used to manage patients. Current practices for patient selection and management, screening tests, and dosing guidelines for intrathecal drug delivery systems are discussed.
AB - Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the 'gold standard,' and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes. Patient selection criteria for cancer and nonmalignant pain are similar; however, a more comprehensive psychological and social assessment is required for patients with nonmalignant pain. In addition, all patients (those with cancer or nonmalignant pain) must exhibit a positive response to an epidural or intrathecal screening test. A multidisciplinary team approach, involving psychologists, nurses, physical therapists, social workers, and spiritual leaders should be used to manage patients. Current practices for patient selection and management, screening tests, and dosing guidelines for intrathecal drug delivery systems are discussed.
KW - Cancer
KW - Cancer pain
KW - Intrathecal therapy
KW - Nonmalignant pain
KW - Opioids
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U2 - 10.1046/j.1525-1403.1999.00055.x
DO - 10.1046/j.1525-1403.1999.00055.x
M3 - Article
C2 - 22151109
AN - SCOPUS:0033002847
SN - 1094-7159
VL - 2
SP - 55
EP - 66
JO - Neuromodulation
JF - Neuromodulation
IS - 2
ER -