Abd-Sayed Alaa, Fiala Kenneth, Weisbein Jacqueline, Chopra Pooja, Lam Christopher, Kalia Hemant, Jassal Navdeep, Gulati Amitabh, Sayed Dawood, Deer Timothy
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792-3272, USA.
Napa Valley Orthopedic Medical Group, Napa, CA, 94558, USA.
J Pain Res. 2022 May 3;15:1305-1314. doi: 10.2147/JPR.S344409. eCollection 2022.
The use of intrathecal drug delivery for chronic and cancer pain medicine has been established for decades. However, optimization and utilization of this technique still lag behind other modalities for pain control. Some of this may be due to variability of surgical technique, medication usage and education. It is currently unclear on whether or not practitioners follow available algorithms for the use of intrathecal drug delivery systems.
A survey developed by the American Society of Pain and Neuroscience (ASPN) was sent to its members via email using the cloud-based . After 30 days of being available, 159 different providers responded to the survey that consisted of 31 various multiple choice and free response questions. Each question was not required and the number of responses to each varied from 128 to 159.
Approximately 9% of those who successfully received and opened the email containing the survey responded, likely due to a small number of providers working with intrathecal drug delivery systems. Eighty-six of respondents practice medicine in the United States, and 87% of the respondents were attending physicians. A majority of respondents, approximately 74%, were board certified in pain medicine with 69% of respondents being train in anesthesiology. The first and second most used medications for intrathecal pump trial were morphine and fentanyl, respectively. Most respondents, approximately 96%, provide pre-operative/intra-operative antibiotics. The most common first-choice medication for implanted intrathecal pumps was also morphine with the most common implanted location being the abdomen.
Interestingly, there is currently fairly substantial variation in the way providers utilize intrathecal pump delivery for both chronic and cancer pain. There is variation from the training background of the providers providing care, to the pre-implantation trial medications, to where the pump is implanted for each patient, to if the patient has the option to give themselves boluses once implanted. Further research is needed to elucidate current and best practices for intrathecal drug delivery system trials, implantations, and utilization.
鞘内药物递送用于慢性疼痛和癌症疼痛治疗已有数十年历史。然而，该技术的优化和应用仍落后于其他疼痛控制方式。部分原因可能是手术技术、药物使用和培训存在差异。目前尚不清楚从业者是否遵循鞘内药物递送系统的现有使用算法。
美国疼痛与神经科学学会（ASPN）开发的一项调查问卷通过基于云的方式通过电子邮件发送给其成员。问卷发布30天后，159位不同的提供者回复了该调查，调查包含31个多种选择题和自由回答问题。每个问题并非必填项，每个问题的回复数量从128到159不等。
成功接收并打开包含调查问卷电子邮件的人中约9%进行了回复，这可能是因为使用鞘内药物递送系统的提供者数量较少。86位受访者在美国行医，87%的受访者是主治医师。大多数受访者（约74%）拥有疼痛医学专业认证，69%的受访者接受过麻醉学培训。鞘内泵试验最常使用的前两种药物分别是吗啡和芬太尼。大多数受访者（约96%）会在术前/术中使用抗生素。植入式鞘内泵最常用的首选药物也是吗啡，最常见的植入部位是腹部。
有趣的是，目前提供者在使用鞘内泵治疗慢性疼痛和癌症疼痛的方式上存在相当大的差异。从提供护理的提供者的培训背景，到植入前试验药物，再到每个患者泵的植入位置，以及患者植入后是否有自行推注药物的选择，都存在差异。需要进一步研究以阐明鞘内药物递送系统试验、植入和应用的当前最佳实践。
