Intrathecal Drug Delivery Systems Survey: Trends in Utilization in Pain Practice.

Background: 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.
Methods: A survey developed by the American Society of Pain and Neuroscience (ASPN) was sent to its members via email using the cloud-based SurveyMonkey . 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.
Results: 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.
Conclusion: 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.
Competing Interests: Dr Jacqueline Weisbein received fees for consulting and research form Medtronic, Abbott, Saluda, and Boston Scientific, outside the submitted work. Dr Pooja Chopra reports personal fees from Flowonix, outside the submitted work. Dr Amitabh Gulati reports personal fees from Medtronic, personal fees from Flowonix, personal fees from AIS Healthcare, personal fees from Tremeau medical, personal fees from SPR therapeutics, personal fees from Nalu Medical, during the conduct of the study. Dr Dawood Sayed reports personal fees from Medtronic, personal fees from Flowonix, outside the submitted work. Dr Timothy Deer reports personal fees from Medtronic, during the conduct of the study; personal fees from Abbott fees, Vertos, Flowonix, SpineThera, Saluda, Mainstay, Nalu, Cornerloc, Ethos, SPR Therapeutic, SI Bone, Nevro, Boston Scientific, PainTeq, Tissue Teq, and Avanos, outside the submitted work. In addition, Dr Timothy Deer has a patent Abbott pending to Abbott & Tim Deer.
(© 2022 Abd-Sayed et al.)