Medical practice perspective: identification and mitigation of risk factors for mortality associated with intrathecal opioids for non-cancer pain

Pain Medicine : the Official Journal of the American Academy of Pain Medicine
Robert J CoffeyMichael S Turner

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, 1994·American Journal of Public Health·N B OldridgeA R Rimm
Sep 1, 1996·Journal of Neurosurgery·M Winkelmüller, W Winkelmüller
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
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 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
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

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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
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
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
Feb 16, 2021·Expert Opinion on Drug Safety·Alan ChalilCharles E Argoff
Apr 28, 2011·Current Opinion in Supportive and Palliative Care

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