CONTROL WORKFLOW TARGETED DRUG DELIVERY

Purpose of Control Workflow

Hero image of Medtronic SynchroMed II programmable pump used to administer targeted drug delivery therapy for chronic pain

The Control Workflow for Targeted Drug Delivery (TDD) is an approach to help eliminate systemic opioids and provide effective pain relief. The purpose of this workflow is to provide a treatment option for chronic pain utilizing low-dose TDD. Patients should receive appropriate pain treatment based on careful consideration of benefits and risks of treatment options.

TDD has demonstrated a substantial reduction in the amount of drug required to effectively manage chronic pain. By having an outlined workflow, we are hoping to reduce perceived barriers to the TDD therapy.

Targeted Drug Delivery (TDD) helps eliminate systemic opioids in treating chronic pain

HELP ELIMINATE SYSTEMIC OPIOIDS

Targeted Drug Delivery (TDD) allows physician to titrate to the lowest effective dose for the patient

TITRATE TO THE LOWEST EFFECTIVE DRUG DOSE FOR THE PATIENT

Targeted Drug Delivery (TDD) brings relief from chronic pain to an underserved patient population

TREAT AN UNDERSERVED POPULATION

A Solution to Systemic Opioids

Dr. Jay Grider explains the opioid epidemic and states that Targeted Drug Delivery (TDD) can help avoid the epidemiological issues of long-term opioid therapy.
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Patient Selection for TDD Control Workflow2

Although TDD can be used for many different types of pain, consider this selection criteria for the Control Workflow:

  • Minimum Visual Analogue Score (VAS) score of 5
  • Primary back pain
  • Intolerable side effects with systemic medication or above CDC systemic dose recommendation

Systemic Opiate Weaning Protocol3

A complete taper of systemic opiate medication and a drug “holiday” will allow you to titrate to the lowest effective dose and manage dose escalation. The opioid holiday has been shown to drive lower initial dose compared to similar studies without a holiday.

  • 100% TAPER. Tailor the duration and steps of taper to the individual patient.
  • OPIOID HOLIDAY. Appropriate for your patient up to 6 weeks. 

Pump Implant and Initiating Therapy

Illustrated rendering of spine indicating placement of programmable pump and catheter for Targeted Drug Delivery (TDD) therapy

The Control Workflow aims to phase out systemic opioids and provide effective pain relief using intrathecal opioids delivered by an implanted programmable pump and catheter. Once the pump is in place, it may take several months to optimize drug delivery.

Considerations for Catheter Placement

  • Location of receptors for back pain4: T9 and T10
  • Posterior catheter tip placement2

Initiating Therapy2

  • Start at trial dose.
  • When considering drug concentration, think about pump size and refill date.

TDD Patient Safety

Safety protocols enable you and your team to react quickly and effectively to potential concerns. Whenever initiating a bolus or dose adjustment, make sure to monitor the patient for adverse reactions.

Potential Safety Benefits of Control Workflow:

  • The severity of a pocket fill may be lower due to the reduced drug concentration.
  • The severity of adverse events may be reduced due to the decreased drug concentration.

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PATIENT EDUCATION

Tell your patients where to find more information about Medtronic Pain Therapies.

GO TO PATIENT INFO

1

Ruan X. Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician. 2007;10:357-366.

2

Medtronic data on file.

3

Grider JS. Harned ME, Etscheidt MA. Patient Selection and outcomes using a low-dose intrathecal opioid trialing method for chronic nonmalignant pain. Pain Physician. 2011: 14: 343- 351.

4

Netter F. Atlas of Human Anatomy. 5th ed. Philadelphia. PA: Saunders Elsevier. 2010.