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Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis.
Neuromodulation. 2020 Jun 28 [Online ahead of print]N

Abstract

OBJECTIVES

Patients treated with intrathecal therapy frequently require opioid dose increases to maintain analgesia. The kinetics of intrathecal opioid dose escalation are poorly understood. We hypothesized that antidepressant use, antiepileptic use, and lower baseline oral opioid intake prior to intrathecal pump implantation will be protective against intrathecal opioid dose escalation.

MATERIALS AND METHODS

Targeted drug delivery medication doses were collected from patients who had an intrathecal pump implanted between 2007 and 2016. From a sample size of 136 patients, the association between antidepressant, antiepileptic, and oral opioid use with intrathecal dose escalation was assessed using statistical models.

RESULTS

Individuals using an antiepileptic had an estimated ratio of means (97.5% CI) of opioid consumption of 0.91 (97.5% CI: [0.48, 1.73], p = 0.74) at six months, 0.83 ([0.43, 1.58], p = 0.51) at 12 months, and 0.77 ([0.40, 1.45], p = 0.36) at 24 months. Patients prescribed antidepressants had an estimated ratio of means (97.5% CI) of 1.43 ([0.77, 2.65], p = 0.19) at six months, 1.41 ([0.76, 2.63], p = 0.22) at 12 months, and 1.33 ([0.70, 2.51], p = 0.31) at 24 months. In our secondary analysis of pre-implant oral opioid use, patients treated with high oral opioid doses had a similar pattern of intrathecal dose escalation when compared to patients using low doses of oral opioids.

CONCLUSIONS

Use of antiepileptics, antidepressants, or low oral opioid doses was not associated with attenuation of intrathecal dose escalation. Intrathecal opioid dose escalation was observed to occur similarly, regardless of baseline oral analgesics concomitantly employed.

Authors+Show Affiliations

Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Pain Management and Evidence Based Pain Research, Cleveland Clinic Foundation, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32596988

Citation

Hale, Jason, et al. "Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: a Retrospective Analysis." Neuromodulation : Journal of the International Neuromodulation Society, 2020.
Hale J, Prayson N, Liang C, et al. Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis. Neuromodulation. 2020.
Hale, J., Prayson, N., Liang, C., & Bolash, R. (2020). Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis. Neuromodulation : Journal of the International Neuromodulation Society. https://doi.org/10.1111/ner.13214
Hale J, et al. Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: a Retrospective Analysis. Neuromodulation. 2020 Jun 28; PubMed PMID: 32596988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis. AU - Hale,Jason, AU - Prayson,Nicholas, AU - Liang,Chen, AU - Bolash,Robert, Y1 - 2020/06/28/ PY - 2019/12/18/received PY - 2020/04/26/revised PY - 2020/05/10/accepted PY - 2020/6/30/entrez KW - Antidepressants KW - antiepileptics KW - intrathecal opioid KW - intrathecal pump JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation N2 - OBJECTIVES: Patients treated with intrathecal therapy frequently require opioid dose increases to maintain analgesia. The kinetics of intrathecal opioid dose escalation are poorly understood. We hypothesized that antidepressant use, antiepileptic use, and lower baseline oral opioid intake prior to intrathecal pump implantation will be protective against intrathecal opioid dose escalation. MATERIALS AND METHODS: Targeted drug delivery medication doses were collected from patients who had an intrathecal pump implanted between 2007 and 2016. From a sample size of 136 patients, the association between antidepressant, antiepileptic, and oral opioid use with intrathecal dose escalation was assessed using statistical models. RESULTS: Individuals using an antiepileptic had an estimated ratio of means (97.5% CI) of opioid consumption of 0.91 (97.5% CI: [0.48, 1.73], p = 0.74) at six months, 0.83 ([0.43, 1.58], p = 0.51) at 12 months, and 0.77 ([0.40, 1.45], p = 0.36) at 24 months. Patients prescribed antidepressants had an estimated ratio of means (97.5% CI) of 1.43 ([0.77, 2.65], p = 0.19) at six months, 1.41 ([0.76, 2.63], p = 0.22) at 12 months, and 1.33 ([0.70, 2.51], p = 0.31) at 24 months. In our secondary analysis of pre-implant oral opioid use, patients treated with high oral opioid doses had a similar pattern of intrathecal dose escalation when compared to patients using low doses of oral opioids. CONCLUSIONS: Use of antiepileptics, antidepressants, or low oral opioid doses was not associated with attenuation of intrathecal dose escalation. Intrathecal opioid dose escalation was observed to occur similarly, regardless of baseline oral analgesics concomitantly employed. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/32596988/Association_Between_Oral_Pain_Medications_and_Intrathecal_Opioid_Dose_Escalation:_A_Retrospective_Analysis L2 - https://doi.org/10.1111/ner.13214 DB - PRIME DP - Unbound Medicine ER -
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