Abstract
The authors recently determined that early and longer term mortality after initiation or reinitiation of intrathecal opioid therapy is higher than previously appreciated: 0.088% within 3 days, 0.39% at 1 month, and 3.89% at 1 year. These rates were 7.5 (confidence interval, 5.7-9.8), 3.4 (confidence interval, 2.9-3.8), and 2.7 (confidence interval, 2.6-2.8) times higher, respectively, at each interval than expected based on the age- and gender-matched general U.S. population. A substantial portion of this excess mortality is probably therapy related and cannot be entirely accounted for by underlying demographic or patient-related factors, or by device malfunctions. We also analyzed multiple complementary internal, governmental, and insurance databases to quantify mortality and to identify medical practice patterns that appear to be associated with patient mortality risks, and to suggest measures for physicians and health care facilities to consider in order to reduce those risks. Both of those objectives involve judgments, which may be controversial and are subject to practical limitations. Multiple clinical and patient- or therapy-related factors appear to increase the risk for early post-implant mortality. Specific risk mitig...Continue Reading
References
Aug 1, 1989·Neurosurgery·L F Ramirez, R Thisted
Aug 1, 1989·Neurosurgery·L F Ramirez, R Thisted
Jan 1, 1987·Journal of Chronic Diseases·M E CharlsonC R MacKenzie
Aug 1, 1994·American Journal of Public Health·N B OldridgeA R Rimm
Sep 1, 1996·Journal of Neurosurgery·M Winkelmüller, W Winkelmüller
Mar 1, 1996·Neurosurgery·G W BritzM Kliot
Feb 5, 1999·Neurosurgery·V C Anderson, K J Burchiel
Jun 26, 1999·The Clinical Journal of Pain·J BrownU Tutak
Aug 18, 1999·JAMA : the Journal of the American Medical Association·J Stephenson
Sep 16, 2000·Journal of Pain and Symptom Management·G BennettT Yaksh
Nov 9, 2000·The New England Journal of Medicine·P L BaileyD E Rollins
Jan 9, 2001·Journal of Clinical Epidemiology·C N KlabundeJ L Warren
Sep 29, 2001·Journal of Pain and Symptom Management·N G RainovW Burkert
Dec 19, 2001·Medical Care·John SantelliArthur Elster
Sep 28, 2002·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Thomas J SmithUNKNOWN Implantable Drug Delivery Systems Study Group
Mar 5, 2004·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Timothy DeerKim Burchiel
May 26, 2004·Pain·Mark A ThimineurMohan S Vodapally
May 29, 2004·Journal of Pain and Symptom Management·Samuel J HassenbuschK Dean Willis
May 24, 2006·Journal of Pain and Symptom Management·Richard L RauckUNKNOWN Ziconotide 301 Study Group
Jun 19, 2007·The Clinical Journal of Pain·Alì ShaladiRoberto Dall'Ara
Sep 7, 2007·Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine·James M WalkerKevin C Shilling
May 21, 2008·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Lynn R WebsterBrydon J B Grant
Jul 30, 2008·Archives of Internal Medicine·David P PhillipsMegan M Eguchi
Dec 24, 2009·Anesthesiology·James P Rathmell, Matthew J Miller
Dec 24, 2009·Anesthesiology·Robert J CoffeyMichael S Turner
Oct 1, 2007·Neuromodulation : Journal of the International Neuromodulation Society·Timothy DeerAnne Ver Donck
Oct 1, 2007·Neuromodulation : Journal of the International Neuromodulation Society·Peter StaatsSean Lilienfeld
Jan 1, 2008·Neuromodulation : Journal of the International Neuromodulation Society·David J EllisUNKNOWN Elan Study 95-002 Group
Oct 1, 2006·Neuromodulation : Journal of the International Neuromodulation Society·Daniel M DoleysTimothy Ness
Citations
Oct 14, 2011·Neuromodulation : Journal of the International Neuromodulation Society·Robert M Levy
Apr 13, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Jun 8, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Robert M Levy
Jul 4, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Aug 2, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Jan 1, 2012·Pain Management·R Carter W JonesMark S Wallace
Dec 18, 2013·Current Pain and Headache Reports·Salim M Hayek, Michael C Hanes
Jul 21, 2010·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Timothy R Deer
May 20, 2015·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jason E PopeW Porter McRoberts
Feb 18, 2014·Neuromodulation : Journal of the International Neuromodulation Society·Michael Saulino, Michael Gofeld
Jan 23, 2014·Neuromodulation : Journal of the International Neuromodulation Society·Joshua PragerLisa Stearns
Nov 29, 2015·The Medical Clinics of North America·Heather SmithJulie G Pilitsis
Aug 15, 2014·Neuromodulation : Journal of the International Neuromodulation Society·Paolo MainoRoberto S G M Perez
Feb 2, 2015·Current Pain and Headache Reports·Syed Rizvi, Krishna Kumar
Feb 26, 2016·Pain Practice : the Official Journal of World Institute of Pain·Jason E PopeSteven Falowski
Sep 8, 2016·Pain Practice : the Official Journal of World Institute of Pain·Joseph V PergolizziJo Ann LeQuang
Apr 11, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Paolo MainoEva Koetsier
Sep 10, 2011·Journal of Neurosurgical Anesthesiology·Rui V DuarteRobert L Ashford
May 17, 2019·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Gilles AllanoAntoine Lemaire
Jan 4, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Jan 4, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Jan 4, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Jan 4, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Oct 23, 2019·Open Medicine·Antonello SicaAlfonso Papa
Feb 16, 2021·Expert Opinion on Drug Safety·Alan ChalilCharles E Argoff
Apr 28, 2011·Current Opinion in Supportive and Palliative Care