Implantable Infusion Pump For Pain And Spasticity

Implantable infusion pumps can provide long-term drug infusion at constant or variable rates; several devices are commercially available. Pain For individuals who have cancer pain who receive intravenous, intrathecal, or epidural injection of opioids with an implantable infusion pump, the evidence includes randomized controlled trials and a systematic review. Relevant outcomes are symptoms, quality of life, and treatment-related morbidity. A systematic review identified 2 randomized controlled trials on implantable infusion pumps for cancer pain; one did not find a difference between groups in pain scores but was likely underpowered. The other found a higher rate of pain reduction with an implantable pump compared with medical management alone; the difference between groups was marginally significant. The evidence is insufficient to determine the effects of the technology on health outcomes. For individuals who have severe, chronic, intractable noncancer pain who receive intravenous, intrathecal, or epidural injection of opioids with an implantable infusion pump, the evidence includes observational studies and systematic reviews. Relevant outcomes are symptoms, quality of life, and treatment-related morbidity. A 2013 systematic review of retrospective and prospective cohort studies indicated reduced pain with intrathecal opioids. A 2009 systematic review included 4 observational studies; 2 showed positive results for pain relief, 1 study had negative results, and results for the fourth were unavailable. The evidence is insufficient to determine the effects of the technology on health outcomes. Severe Spasticity For individuals who have severe spasticity of cerebral or spinal cord origin, unresponsive to or intolerant of oral therapy, who receive intrathecal baclofen with an implantable infusion pump, the evidence includes observational studies, a nonrandomized comparative study, and systematic reviews. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatment-related morbidity. Uncontrolled studies and systematic reviews of these studies have reported improvements in spasticity for patients treated using implantable infusion pumps. A nonrandomized comparative study comparing patients using implantable infusion pumps for baclofen delivery with patients on a wait list found significantly greater reductions in spasticity in the group with pump implantation on some outcomes, but not others. Randomized controlled trials are lacking. The evidence is insufficient to determine the effects of the technology on health outcomes. Because of the strong rationale for use, suggestive evidence, and support from clinical guidelines, infusion pumps may be considered medically necessary for cancer pain, chronic, intractable noncancer pain, and severe spasticity. <a id="