Regional Anesthesia and Pain Medicine最新文献

{"title":"Sequential flex mode for intrathecal infusion after continuous mode failure: a retrospective follow-up study for refractory cancer pain management.","authors":"Florent Bienfait, Sabrina Jubier-Hamon, Valerie Seegers, Thierry Delorme, Arthur Julienne, Jeremy Sorrieul, Nathalie Lebrec, Denis Dupoiron","doi":"10.1136/rapm-2025-107217","DOIUrl":"https://doi.org/10.1136/rapm-2025-107217","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal drug delivery systems (IDDS) have long been recommended to relieve intractable cancer pain. Intrathecal treatment administered by continuous flow rate can result in suboptimal analgesia, despite daily dosage escalation. The distribution of drugs in the cerebrospinal fluid remains limited during intrathecal infusion.Thus, despite catheter localization close to the target level in the intrathecal space, it is challenging to maintain effective therapy despite a considerable increase in continuous pump flow rate. This led to the consideration of how to cover more dermatomes with an already implanted IDDS. Literature suggests that using large boluses, in addition to conventional continuous infusion, may help intrathecal drug spread. An innovative infusion mode, defined as the sequential flex mode, using a basal flow rate with large boluses, could provide better pain relief than the usual continuous flow rate mode.</p><p><strong>Methods: </strong>The sequential flex mode was used only for patients suffering despite a high continuous flow rate and a high daily drug dosage. The main objective of this retrospective monocentric study was to determine if patients achieved better pain relief with the sequential flex mode than the continuous flow rate mode.</p><p><strong>Results: </strong>53 patients were included. 71.7%±6.43% of the patients achieved at least 30% Numerical Rating Scale (NRS) pain reduction with the sequential flex mode, and in 52.5%±7.12% of the switches, the pain relief achieved was even greater than 50% NRS reduction. The median NRS evaluation showed a significant pain reduction after the switch from 6.4 (SD 2.0) to 3.3 (SD 2.2) (p<0.0001). Intrathecal morphine and ropivacaine daily doses remained stable in the switch success group around the switch. Adverse effects occurred in 12 switches out of 59 (20.3%±6.06%), and were non-serious in nature, most commonly increased anxiety.</p><p><strong>Conclusion: </strong>The sequential flex intrathecal infusion mode may provide better pain relief when the continuous mode loses efficacy, as well as help to reduce daily dosage escalation.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1041-1047"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications leading to device explant in patients with chronic non-cancer pain receiving intrathecal drug delivery.","authors":"Salim Michel Hayek, Sameam Shahrestani, Jacob Blank, Beatriz Feijo, Jose Reyes, Phu Duong, Muskan Sidhu, Qiuchen Li, Ryan Shaner, Jennifer Murphy, Michael D Staudt","doi":"10.1136/rapm-2025-107223","DOIUrl":"10.1136/rapm-2025-107223","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal drug delivery (IDD) is often used in the management of refractory chronic non-cancer pain, particularly persistent chronic low back pain in the setting of previous lumbar spine surgery (persistent spinal pain syndrome type 2 (PSPS2)). Complications of IDD leading to device explant in patients with chronic non-cancer pain have not been well characterized. This study evaluated complications leading to device explants in a large cohort of patients with chronic non-cancer pain treated with IDD.</p><p><strong>Methods: </strong>A retrospective study was undertaken on patients with chronic non-cancer pain who underwent device implants by Pain Medicine physicians between June 2009 and December 2022 at a large tertiary center academic practice. Data collection included demographic and comorbidity data as well as the various indications for device explant.</p><p><strong>Results: </strong>Data were collected from 215 patients with chronic non-cancer pain who underwent device implant and were followed for a mean duration of 80±48.8 months. The average age at the time of implant was 63.24±12.05 years, and the majority (184 patients) suffered from PSPS2. The explant rate was 26.1%, and device-related infection was the leading cause of explants occurring in 9.3% of patients and 5.9% of device surgeries. Loss of analgesic efficacy leading to device explant occurred in 5.6% of patients, but this was significantly less than the explant rate due to habituation noted with spinal cord stimulation (SCS) in a similar patient population. compared with other complications leading to device explants, infections had a much earlier time interval from device implant to explant. No demographic or comorbidity factors correlated with device explants.</p><p><strong>Conclusion: </strong>Device-related infections are the leading cause for explants in IDD for chronic non-cancer pain. Explants due to loss of analgesic efficacy occurred at a lesser frequency with IDD compared with SCS explants in a similar patient population.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1048-1054"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online questions and information quality surrounding the novel non-opioid analgesic suzetrigine: analysis of publicly available web content.","authors":"Renee Ren, Junying Wang, Tina Chen, Charles Williams, Maaz Shah Khan, Meghan Kirksey, Daniel Maalouf, Jashvant Poeran, Alexandra Sideris","doi":"10.1136/rapm-2026-107803","DOIUrl":"10.1136/rapm-2026-107803","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal drug delivery systems: an overview of cost-effectiveness evidence.","authors":"Rui V Duarte, Lazaros Andronis, Sam Eldabe","doi":"10.1136/rapm-2025-107218","DOIUrl":"https://doi.org/10.1136/rapm-2025-107218","url":null,"abstract":"<p><p>Economic evaluations, which systematically compare the costs and health-related outcomes of health interventions, are essential for informing resource allocation decisions, particularly in the context of financial constraints and limited healthcare budgets. Intrathecal drug delivery (ITDD) systems are widely used for the management of cancer pain, chronic non-cancer pain, and spasticity. However, ITDD involves substantial upfront costs, ongoing maintenance expenses, and potential complications. This article provides an overview of health-related economic evaluation principles and of the evidence on the cost-effectiveness of ITDD systems across cancer pain, chronic non-cancer pain, and spasticity. Published studies include both full and partial economic evaluations, conducted from varying perspectives and in diverse healthcare settings. Most analyses suggest that ITDD is cost-effective compared with conventional management strategies, particularly for cancer-related pain and spasticity. However, the robustness of these findings is limited by methodological heterogeneity and reliance on effectiveness data that are often derived from small or uncontrolled studies. Evidence for chronic non-cancer pain is especially sparse and inconsistent, highlighting the need for further research using rigorous designs and comprehensive cost data. Given the high costs and complexity of ITDD systems, strengthening the evidence base on their clinical and economic value is critical to support informed decision-making by health technology assessment bodies and payers. Future studies should prioritize comparative effectiveness research and long-term economic modeling to address current gaps and uncertainties.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1097-1103"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and symptom severity outcomes in patients with cancer before and after intrathecal drug delivery: mixed model analysis in 222 cases.","authors":"Daniel W Odell, Jill E Sindt, Shannon McNeal, Kristen Michelle Saad, Angela P Presson, Chong Zhang, Shane E Brogan","doi":"10.1136/rapm-2026-107984","DOIUrl":"https://doi.org/10.1136/rapm-2026-107984","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related pain is common and difficult to manage, and many patients require opioid therapy with dose-limiting toxicity. As pain progresses, opioid escalation may result in adverse effects and suboptimal analgesia. Intrathecal drug delivery (IDD) provides targeted analgesia and may reduce systemic toxicity. This study evaluated temporal trends in pain and symptom burden before and after IDD initiation.</p><p><strong>Methods: </strong>Retrospective analysis of longitudinal Brief Pain Inventory (BPI) and Condensed Memorial Symptom Assessment Scale (CMSAS) scores in 435 patients with cancer pain treated with IDD at an academic cancer center between 2013 and 2023. Inclusion required ≥1 symptom assessment within 30 days prior to implantation and survival >10 days postimplant. Primary outcomes were changes in BPI-Severity (BPI-SEV), BPI-Interference (BPI-INT) and CMSAS-Physical (CMSAS-PHYS) after IDD, estimated using joint longitudinal-survival models to account for informative dropout due to death over 1 year. Pre-IDD symptom trajectories were modeled separately. Secondary outcomes included remaining BPI and CMSAS domains assessed at prespecified time points up to 1 year, analyzed descriptively.</p><p><strong>Results: </strong>222 patients met inclusion criteria. During follow-up, 91% discontinued systemic opioids. In joint models over the first 90 days after implantation, BPI-SEV decreased by 0.014 units/day (n=219; 95% CI -0.020 to -0.009; p<0.001), BPI-INT decreased by 0.020 units/day (n=209; 95% CI -0.029 to -0.011; p<0.001) and CMSAS-PHYS improved by 0.004 units per day (n=195; 95% CI -0.006 to -0.001; p=0.002). Symptom trajectories worsened prior to implantation and improved following IDD initiation. Mean composite scores improved significantly across all time points for BPI-SEV, BPI-INT and CMSAS-PHYS.</p><p><strong>Conclusions: </strong>Among patients with advanced cancer, pain and symptom burden worsened prior to IDD but improved within 90 days after implantation, with sustained benefits observed up to 1 year.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1055-1064"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implanted intrathecal drug delivery systems: a narrative review for the perioperative, obstetric, and intensive care anesthesiologist.","authors":"Robert Jenkinson, Tyson Jergensen, Eellan Sivanesan, Lisa Leffert, Shane E Brogan","doi":"10.1136/rapm-2025-107458","DOIUrl":"https://doi.org/10.1136/rapm-2025-107458","url":null,"abstract":"<p><strong>Background/importance: </strong>Patients with implanted intrathecal drug delivery systems (IDDS) present unique challenges for anesthesiologists in the perioperative, peripartum, and intensive care settings. A comprehensive and practical review on this topic is needed.</p><p><strong>Objective: </strong>This narrative review highlights essential knowledge required for safe management of this patient population, including familiarity with: (1) IDDS technology and therapeutics; (2) the appropriateness of neuraxial procedures in IDDS patients; and (3) IDDS-related complications in the operating room and intensive care unit.</p><p><strong>Evidence reviewed: </strong>A literature search was conducted using PubMed/MEDLINE and Google Scholar with the following keywords: intrathecal pump, intrathecal drug delivery, intrathecal morphine, perioperative medicine, labor anesthesia, regional anesthesia, and intrathecal baclofen. Reference lists of relevant articles were manually screened to identify additional pertinent studies, case series, and case reports. Intrathecal pump device manuals were also reviewed to obtain technical details.</p><p><strong>Findings: </strong>Based on the available evidence, we provide background medical knowledge and guidance regarding IDDS across five main sections: intrathecal pharmacology, considerations related to IDDS implantation, perioperative care of patients with IDDS, neuraxial anesthesia, and device-related safety concerns. In each section, we summarize available literature and provide contextual interpretation informed by expert opinion when evidence is limited.</p><p><strong>Conclusions: </strong>This review provides a comprehensive overview of current best practices for the perioperative management of patients with IDDS, emphasizing evidence-based approaches to optimize clinical outcomes and ensure patient safety. Key topics covered include intrathecal medications, their performance under MRI, and precautions prior to attempting any neuraxial access in patients with IDDS.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1004-1011"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal drug delivery: past, present, and future.","authors":"Salim Michel Hayek, Sam Eldabe","doi":"10.1136/rapm-2025-107225","DOIUrl":"https://doi.org/10.1136/rapm-2025-107225","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"993-994"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncommon indications in chronic pain for intrathecal drug delivery systems: a narrative review of the literature.","authors":"Priyanka Singla, Gabrielle Li, Lynn Kohan","doi":"10.1136/rapm-2025-107220","DOIUrl":"https://doi.org/10.1136/rapm-2025-107220","url":null,"abstract":"<p><p>Intrathecal drug delivery systems (IDDS) have been used successfully for a number of refractory chronic pain conditions. The most common pain indications for the use of IDDS include cancer-related pain and postlaminectomy syndrome. IDDS can also be used to treat a variety of other less common refractory pain conditions, including central neuropathic pain, peripheral neuropathic pain and craniofacial pain. The aim of this article was to review the existing literature on the efficacy and clinical utility of IDDS for the management of uncommon pain indications, including spinal cord injury-related pain, transverse myelitis, diabetic painful neuropathy, postherpetic neuralgia and craniofacial pain to inform clinicians on the state of the current evidence of IDDS use in these challenging pain conditions. PubMed, Embase, Web of Science, CINAHL and Cochrane databases were searched with keywords. Additionally, reference lists of retrieved articles and relevant reviews were manually screened to identify additional publications. Articles were screened for relevance using Covidence by three reviewers. Eligible studies included the use of IDDS for refractory uncommon pain conditions. Exclusion criteria included non-English studies, animal studies, studies that focused on non-pain indications and abstracts without accompanied full text. Given heterogeneity and largely descriptive data, findings were analyzed narratively by descriptive categories.The use of IDDS for refractory pain in patients with select pain conditions is supported primarily by observational studies and small clinical trials. Current evidence suggests that the IDDS may provide meaningful analgesia in carefully selected patients with central and peripheral pain, and facial neuropathic pain; however, the magnitude of pain relief and durability of response is variable. These findings are likely reflective of the limited evidence as a result of selective utilization of this therapy in clinical practice. Based on limited evidence, IDDS may provide meaningful clinical benefit in patients with refractory uncommon pain syndromes. Future research can help to define the use of IDDS in this challenging patient population.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1088-1096"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of intrathecal drug delivery systems for the treatment of chronic refractory non-cancer pain.","authors":"Rui V Duarte, Sue Copley, Alan Batterham, Neil Hall, Eric Buchser, Sam Eldabe","doi":"10.1136/rapm-2025-107226","DOIUrl":"10.1136/rapm-2025-107226","url":null,"abstract":"<p><strong>Background/importance: </strong>Intrathecal drug delivery (ITDD) is an established intervention for chronic non-cancer pain, cancer pain, and spasticity. However, ITDD is not routinely commissioned for non-cancer pain in some countries, including England. A comprehensive synthesis of its clinical impact and safety profile in this population is lacking.</p><p><strong>Objective: </strong>To investigate the clinical outcomes and adverse events (AEs) associated with ITDD in adults with chronic non-cancer pain.</p><p><strong>Evidence review: </strong>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a registered protocol (CRD42024581505). Searches across MEDLINE, EMBASE, CENTRAL, and WikiStim until September 2024 were performed to identify studies reporting pain intensity, function, health-related quality of life (HRQoL), and AEs in ITDD recipients with non-cancer pain. Risk of bias was assessed using National Institutes of Health and Cochrane tools. A random-effects meta-analysis was performed on the pain intensity outcome (0-10 scale equivalent) at the 12-month time point.</p><p><strong>Findings: </strong>39 studies (n=2652) were included; 20 single-arm comparisons contributed to meta-analysis. The pooled mean reduction in pain from baseline was 2.64 (95% CI 2.19 to 3.08). Accounting for between-study heterogeneity in effect size, the 95% prediction interval is 0.734 to 4.54 units. The probability that the change from baseline in a new, similar study would be greater than the minimum clinically important difference of 2 units is 75% (95% CI 68% to 83%). All studies reported improvements from baseline in function and HRQoL. Reporting of AEs or discontinuation of ITDD due to AEs was inconsistent. Risk of bias was moderate or high for cohort studies and pre-post studies, low for two crossover randomized trials and one parallel-arm randomized trial, and high for one parallel-arm randomized trial.</p><p><strong>Conclusions: </strong>ITDD is associated with meaningful reductions in pain from baseline, and functional and HRQoL improvement in patients with chronic non-cancer pain. However, the certainty of evidence is low for pain and very low for other outcomes due to study limitations. Improved reporting and controlled trials are needed to strengthen the evidence base, with careful consideration of a control intervention that maintains clinical equipoise.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"995-1003"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal bupivacaine monotherapy in patients with chronic refractory localized pain: a case series.","authors":"Salim Michel Hayek, Cham Alsalak","doi":"10.1136/rapm-2025-107562","DOIUrl":"10.1136/rapm-2025-107562","url":null,"abstract":"<p><strong>Introduction: </strong>Bupivacaine is an established agent in intrathecal drug delivery (IDD), often used in combination with opioids. The efficacy of intrathecal bupivacaine monotherapy has not been reported.</p><p><strong>Methods: </strong>A retrospective case series review was undertaken examining patients with chronic pain who underwent device implants and were receiving intrathecal bupivacaine monotherapy. Data collection included patient demographics as well as pain and IDD characteristics.</p><p><strong>Results: </strong>Five patients receiving intrathecal bupivacaine monotherapy were identified. All patients had regionally localized pain. Duration of IDD ranged from >2 to >12 years. Two of the patients had initially received a combination of an opioid with bupivacaine but were later transitioned to intrathecal bupivacaine monotherapy. Three of the patients were on systemic opioids prior to IDD. All patients experienced ≥50% pain relief and discontinued systemic opioids.</p><p><strong>Conclusion: </strong>IDD with bupivacaine monotherapy may be effective in patients with localized pain. However, more studies are needed to establish the safety and efficacy of intrathecal bupivacaine monotherapy.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1104-1107"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}