Intrathecal drug delivery for chronic non-malignant pain: pharmacological complications, cost effectiveness and long-term outcomes

de Sousa Rego Vieira Duarte, Rui Miguel (2011) Intrathecal drug delivery for chronic non-malignant pain: pharmacological complications, cost effectiveness and long-term outcomes. Doctoral thesis, Birmingham City University.

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Abstract

Background and aims
Intrathecal drug delivery (IDD) is a last resort treatment for the management of severe chronic pain due to its invasive nature, high initial cost, concerns about long-term opioid use and possible complications related to the procedure. Although it has been available since 1981 some of the possible complications of this treatment have only recently been observed and are not fully understood. Additionally the current available literature exploring the longterm effectiveness and cost effectiveness of IDD is limited. The aims of this study were to explore some of the least investigated complications, long-term effectiveness and cost effectiveness of IDD.

Methods
The methodology used included both retrospective and prospective data collection to investigate intrathecal morphine dose escalation, granuloma formation, hormonal effects, bone mineral density (BMD), long-term effectiveness and cost effectiveness of IDD.

Results
A model was developed that allows the prediction of the intrathecal opioid dose at year six of therapy based on year two dose and the duration of pain prior to initiation of intrathecal therapy. An association between opioid concentration and formation of intrathecal granulomas was confirmed for the first time in humans and a tool to assist recognition of asymptomatic granulomas was identified. It was observed that hypogonadism is prevalent in this population and free testosterone is a more reliable method to diagnose this condition. An association between low BMD and hypogonadism as a result of IDD was reported for the first time. Effectiveness of IDD was verified following a mean of 13.5 years of therapy. A new concept with implications for cost analyses was identified.

Conclusion
This study presents a thorough analysis of IDD therapy. Despite potential side effects, this therapy can be effective over periods longer than 10 years in appropriately selected patients. The cost effectiveness of IDD systems was confirmed based on real patients’ data. Most side effects can be prevented with attentive follow-ups.

Item Type: Thesis (Doctoral)
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Divisions: Faculty of Health, Education and Life Sciences > School of Health Sciences
UoA Collections > PhD Theses Collection
Depositing User: Mr Richard Birley
Date Deposited: 24 Jul 2017 15:09
Last Modified: 24 Jul 2017 15:09
URI: http://www.open-access.bcu.ac.uk/id/eprint/4926

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