Intrathecal Drug Delivery for Intractable Pain: Identified Patient Satisfaction Survey Study Comparing Intrathecal Dose With Satisfaction, Pain Relief, and Side Effects

David M Schultz; Caitlin H Bakke; Hannah L Ruble; Collin S Larmour; Jonathan M Hagedorn; Alaa Abd-Elsayed

doi:10.1016/j.neurom.2024.11.006

Intrathecal Drug Delivery for Intractable Pain: Identified Patient Satisfaction Survey Study Comparing Intrathecal Dose With Satisfaction, Pain Relief, and Side Effects

Neuromodulation. 2025 Jan 4:S1094-7159(24)01227-3. doi: 10.1016/j.neurom.2024.11.006. Online ahead of print.

Authors

David M Schultz¹, Caitlin H Bakke², Hannah L Ruble², Collin S Larmour², Jonathan M Hagedorn³, Alaa Abd-Elsayed⁴

Affiliations

¹ Nura Pain Clinic, Minneapolis MN, USA; Department of Anesthesia, Critical Care and Pain Medicine, University of Minnesota, Twin Cities, MN, USA. Electronic address: dschultz@nuraclinics.com.
² Nura Pain Clinic, Minneapolis MN, USA.
³ Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.

PMID: 39755963
DOI: 10.1016/j.neurom.2024.11.006

Abstract

Objectives: Past studies have shown the efficacy of spinal targeted drug delivery (TDD) in pain relief, reduction in opioid use, and cost-effectiveness in long-term management of complex chronic pain. We conducted a survey to determine treatment variables associated with patient satisfaction.

Materials and methods: Patients in a single pain clinic who were implanted with Medtronic pain pumps to relieve intractable pain were identified from our electronic health record. From November 2021 to February 2023, 973 patients with active TDD were identified; 564 completed the 23-question survey, and 560 were included in analyses. Most patients (96.4%) had intrathecal (IT) infusion admixtures containing bupivacaine and opioid. The survey compared satisfaction with IT medication dosages, pain relief, pain diagnosis, catheter tip location, side effects, mental clarity, physical functioning, and healthcare utilization. Outcomes were reported as proportions; p < 0.05 was considered significant.

Results: Most respondents reported good-to-excellent pain relief (63.8%), high satisfaction with TDD (80.7%), improvement in physical functioning (75.0%), and better quality of life (89.7%); 78.5% of respondents reported complete discontinuation or substantial reductions in systemic opioid use. There was a statistically significant relationship between satisfaction and IT medication dose (p = 0.02), with the average dose increasing with higher satisfaction groups. We found that patients on higher doses of IT opioids did not have more bothersome side effects (p = 0.05).

Conclusions: Our data show that the most satisfied respondents had higher IT doses, fewer side effects, and longer duration of TDD therapy. This suggests that higher dose IT admixtures are safe and effective at relieving pain and improving quality of life in patients with complex chronic pain whose condition has failed to respond adequately to other treatments. TDD may be an effective alternative to long-term systemic opioids for well-selected patients willing to accept the risks of invasive procedures.

Keywords: Chronic pain; IT opioid; intrathecal; pain pump; targeted drug delivery.