Neuromodulation in Special Populations: Examining the Efficacy of Stimulation Versus Intrathecal Pump Therapy

Salim M. Hayek, MD, PhD

Associate Professor
Case Western Reserve University
Chief—Division of Pain Medicine
Department of Anesthesiology
University Hospitals Case Medical Center
Cleveland, OH

Certain patient populations with refractory chronic pain pose particular challenges when considering neuromodulation. Guidelines are unclear on the safety or efficacy of implantable devices in patients who are anticoagulated; are younger or older; or suffer from diffuse pain conditions. For example, despite similar starting dose, younger patients with chronic pain (<50 years of age) consume more than twice the average oral opioid dose used by older patients (>70 years of age), an observation that likely reflects increased tolerance in the younger population. Similar data has now emerged for chronic intrathecal opioid infusion therapy. At the 2010 Annual Meeting of the American Academy of Pain Medicine, Dr. Hayek led a session on neuromodulation in diffuse pain syndromes, considerations for chronic anticoagulation and neuromodulation, and the effect of age on intrathecal opioid requirements.

References

Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12(4):699-802.
Coffey RJ, Owens ML, Broste SK, et al. Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain. Anesthesiology. 2009;111(4):881-891.
Patel VB, Manchikanti L, Singh V, et al. Systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain. Pain Physician. 2009;12(2):345-360.

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