1. Applying a Part of the Daily Dose as Boli May Improve Intrathecal Opioid Therapy in Patients With Chronic Pain
- Author
-
Markus Béchir, En-Chul Chang, Tim Reck, and Ulrich Kallenbach
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Intrathecal ,03 medical and health sciences ,Drug Delivery Systems ,0302 clinical medicine ,Bolus (medicine) ,030202 anesthesiology ,medicine ,Humans ,In patient ,education ,Injections, Spinal ,Aged ,Pain Measurement ,education.field_of_study ,business.industry ,Chronic pain ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Analgesics, Opioid ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Neurology ,Opioid ,Anesthesia ,Intermittent bolus ,Quality of Life ,Female ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Follow-Up Studies ,Every Six Hours ,medicine.drug - Abstract
Objectives The speed of intrathecal drug administration (slow continuous infusion vs. rapid bolus application) might influence the efficacy of therapy despite the equal daily dose in both administration patterns. We tested this hypothesis in a small prospective single-centre pilot study in a population of chronic pain patients with intrathecal opioid therapy. Methods Ten patients receiving intrathecal opioids for chronic pain assessed their pain four times daily on a numeric rating scale (NRS), more than the time course of six weeks divided into three blocks of two weeks each: Baseline evaluation (intrathecal pumps with previously established continuous infusion settings), followed by two blinded trial blocks of continuous (same pump parameters as during evaluation) and bolus (40% of daily dose split into four equal boli applied every six hours, with the remaining 60% as background continuous infusion) regimes. Patients were randomized in a crossover fashion. Results 6/10 patients reported significantly lower NRS-scores during bolus as compared to continuous trial blocks while only one patient showed the opposite effect. Overall, bolus trial blocks were associated with a small but significant reduction of NRS-scores (mean −0.56; p
- Published
- 2016