IT therapy for radiculopathy

[lobelsteve]

https://www.painmedicinenews.com/Residency-and-Fellowship/Article/04-23/Intrathecal-Pain-Management-in-Lumbar-Radiculopathy/70057?sub=FB91EF6AF8C99D4BDA1617412032C789116450929F4665EAF77A779E586D57&enl=true&dgid=U080859650&utm_source=enl&utm_content=1&utm_campaign=20230417&pos=1&utm_medium=button

Brilliant idea. What could go wrong?

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[Ducttape]

kind of a junk article.

there is no specific study he can link to that specifically states that lumbar radiculopathy is improved with ITP over standard of care.

The data presented by Rebel et al provide strong evidence for the effectiveness of intrathecal opioids for pain management in patients with lumbar radiculopathy.16 The study demonstrated that intrathecal opioids provided superior pain relief compared with IV morphine in the postoperative period, with reduced analgesic requirements and fewer opioid-related side effects. The ability of intrathecal opioids to allow for early ambulation after surgery is also a significant advantage. These findings suggest that intrathecal opioids may be a viable option for the management of pain in patients with lumbar radiculopathy.16

except he is quoting this article:

Retrospective analysis of high-dose intrathecal morphine for analgesia after pelvic surgery - PubMed

High-dose ITOs combined with a postoperative IV naloxone infusion provided excellent analgesia for major pelvic surgery. The IV naloxone infusion combined with high-dose ITOs appeared to control opioid side effects without affecting analgesia.

pubmed.ncbi.nlm.nih.gov

to summarize this article - a retrospective analysis on patients undergoing pelvic surgery, not lumbar radiculopathy. and given post op as a 1 time dose, not continuous infusion. completely different condition, different use paradigm and different meds...

the other article he points to is Shultz, a survey. not a study.

 

[DrSpine]

Not sure what the point of delivering IT Therapy is. He even said how it provides up to 39 hours. So? Keep coming back? lol Continuous infusion is even more insane. This is probably the worst decisions to make in terms of treatment.

 

[SC Tian]

thanks for bringing up this discussion, a large group in the Boston region does a lot of pumps after failed stimulator trials or insufficient pain relief from long-term sc stimulation, wonder any comments on this? Imo, idds does not work as well for radic, we may need to add bupivacaine to the regimen.

 

[Baron Samedi]

thanks for bringing up this discussion, a large group in the Boston region does a lot of pumps after failed stimulator trials or insufficient pain relief from long-term sc stimulation, wonder any comments on this? Imo, idds does not work as well for radic, we may need to add bupivacaine to the regimen.

Burning the ships worked out alright for Cortés, but achieving symptomatic relief from chronic pain is a far cry from conquering the Aztec Empire.

 

[lobelsteve]

Burning the ships worked out alright for Cortés, but achieving symptomatic relief from chronic pain is a far cry from conquering the Aztec Empire.

If we dump all those patients into Boston Harbor is it now the Boston I T party?

 

[kstarm]

If we dump all those patients into Boston Harbor is it now the Boston I T party?

Someone needs to moderate these posts....

 

[epidural man]

thanks for bringing up this discussion, a large group in the Boston region does a lot of pumps after failed stimulator trials or insufficient pain relief from long-term sc stimulation, wonder any comments on this? Imo, idds does not work as well for radic, we may need to add bupivacaine to the regimen.

Nociception may not be the biggest problem with chronic pain. Going after nociception, sometimes, is hacking at the leaves.

"There are a thousand hacking at the branches of evil to one who is striking at the root."
Henry David Thoreau

 

[SC Tian]

that is Brigham and Women

 

[lobelsteve]

Someone needs to moderate these posts....

That's crazy talk. We can bill for aquatic therapy at the same time.