PATIENT SELECTION: CHRONIC PAIN Targeted Drug Delivery

CHRONIC INTRACTABLE PAIN GUIDELINES1

Patient selection for the treatment of chronic intractable pain requires a closer examination of criteria. In most cases, a psychological evaluation is indicated to examine factors such as patient expectations, psychosomatic components of the pain, and secondary gain motivation.

Selection guidelines for patients with chronic intractable pain include:

  • Patient experiences inadequate pain relief and/or intolerable side effects from systemic opioid therapy
  • Patient has objective evidence of pathology
  • Patient obtains psychological clearance
  • Patient has no untreated substance abuse
  • Patient has sufficient body size to accept the bulk and weight of the pump
  • Clear therapy goals and realistic expectations have been established
  • No contraindications to surgery or the therapy exist
  • Patient has a favorable response to the screening test

CONTRAINDICATIONS

Infection; implant depth greater than 2.5 cm below skin; insufficient body size; spinal anomalies; drugs with preservatives, drug contraindications, drug formulations with pH ≤3, use of catheter access port (CAP) kit for refills or of refill kit for catheter access, blood sampling through CAP in vascular applications, use of Personal Therapy Manager to administer opioid to opioid-naïve patients or to administer ziconotide. See SynchroMed product labeling for more information.


1

Prager, J., et al. (2014), Best Practices for Intrathecal Drug Delivery for Pain. Neuromodulation: Technology at the Neural Interface, 17: 354–372. doi:10.1111/ner.12146.