In the patient who fails a screening test with neurostimulation, when would you consider a screening test for intrathecal drug delivery?
Patients with intractable pain who fail a screening test with neurostimulation may be candidates for intrathecal drug delivery if they meet the general selection criteria for intrathecal analgesic therapy (e.g., patent spinal canal, no allergy to the proposed intrathecal analgesic agent). Neurostimulation is used primarily to treat neuropathic pain, whereas intrathecal drug delivery is used more commonly to treat nociceptive or mixed nociceptive/neuropathic pain. Neuropathic pain is regarded frequently as being relatively opioid resistant, suggesting that intrathecal opioid delivery would be ineffective. However, published reports of outcomes for intrathecal drug delivery indicate that patients with neuropathic pain have outcomes that are similar to those of patients with nociceptive pain (typically regarded as being opioid responsive). Clinical trials have indicated that opioid responsiveness to neuropathic pain falls along a continuum. For those pain syndromes that are relatively non
Related Questions
- In the patient who fails a screening test with neurostimulation, when would you consider a screening test for intrathecal drug delivery?
- For an appropriate candidate for intrathecal drug delivery, what kind of protocol is typically followed for a screening test?
- Are there psychological factors that exclude a patient from being considered for intrathecal drug delivery?
