Background & Aims
Implantable intrathecal (IT) opioid delivery devices have historically been utilised in only the most difficult to treat patients with intractable chronic pain. There continues to be limited literature addressing the effectiveness of long-term IT opioid use. An obstacle to the evaluation of the long-term treatment of chronic pain patients, is often the absence of data collected at the time of their initial presentation. The electronic Persistent Pain Outcomes Collaboration (ePPOC) is an initiative of the Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists (ANZCA), facilitated by the University of Wollongong, providing normative data for comparison, to enable analysis and research into important areas of pain management.(1) The aim of this study is to assess long term pain management outcomes in a cohort of chronic non-cancer pain patients treated with IT opioid pumps, using ePPOC data as a surrogate baseline.
Methods
This study underwent a point in time analysis of a legacy group of 49 patients, using a combination of validated pain assessment questionnaires, consistent with those used by the ePPOC database. The study focussed on a cohort of chronic non-cancer pain patients, who primarily utilise an IT opioid pump for pain management (some with additional adjuvant agents). Patients were recruited from a single pain management centre in Brisbane. This study utilised pain questionnaires consistent with those used by ePPOC: a demographic questionnaire, the Brief Pain Inventory (BPI), the Depression, Anxiety and Stress Scale (DASS), the Pain Catastrophising Questionnaire (PCQ) and the Pain Self-Efficacy Questionnaire (PSEQ). This self-reported data was then compared to the summarised ePPOC baseline data provided by Nicholas et al. (2019), allowing evaluation against entry data for patients presenting to one of 36 pain units across ANZ.(2)
Results
The cohort group of 49 patients compared favourably in terms of the effectiveness of their treatment across all domains assessed. Participants with implanted IT opioid pumps reported significantly lower pain interference (5.5 [moderate] vs 7 [severe]; p<0.001) and pain severity scores (4.3 vs 6.4; p<0.001), than that of Nicholas et al.’s (2019) published data.2 Patients showed significantly lower results for depression (20.2 vs 13.7 [both moderate]; p<0.001), anxiety (9.6 vs 14.1 [both moderate]; p<0.01), stress (15.5 [mild] vs 21 [moderate]; p<0.001), rumination (6.9 vs 10; p<0.001), magnification (3.8 vs 5.9; p<0.001), helplessness (9.7 vs 14.1; p<0.001) and general catastrophising (20.4 vs 29.8; p<0.001). The study group also demonstrated significantly better self-efficacy (p?0.01) than those in Nicholas et al.’s cohort.(2)
Conclusions
Overall, this study of a legacy cohort with long term use of implanted IT opioid pumps indicates participants compared well in comprehensive pain measures to the published baseline data. This suggests there is a role for IT opioid pumps in managing selective complex chronic pain patients, in a comprehensive multidisciplinary approach to pain management. The ePPOC data as published by Nicholas et al. was found to be an effective surrogate baseline comparator allowing assessment of treatment in a legacy group of patients for whom initial presentation data was unavailable.
References
1.www.uow.edu.au. (n.d.). About ePPOC – University of Wollongong – UOW. [online] Available at: https://www.uow.edu.au/ahsri/eppoc/about/ [Accessed 22 Jan. 2024].
2.Nicholas MK, Costa DSJ, Blanchard M, Tardif H, Asghari A, Blyth FM. Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers. Pain 2019;160(5):1156-65.
3.Wilkes D. Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency. J Pain Res 2014;7:571-7.
Presenting Author
Orla Moore
Poster Authors
Orla Moore
BSc
University of Queensland
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Intrathecal Drug Delivery