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Role of Intrathecal Polyanalgesia- Its Cost Impact and Role in Recapturing Pain Control Dr. Krishna Kumar, M.B., M.S., F.R.C.S. (C), F.A.C.S. Syed Rizvi.

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Presentation on theme: "Role of Intrathecal Polyanalgesia- Its Cost Impact and Role in Recapturing Pain Control Dr. Krishna Kumar, M.B., M.S., F.R.C.S. (C), F.A.C.S. Syed Rizvi."— Presentation transcript:

1 Role of Intrathecal Polyanalgesia- Its Cost Impact and Role in Recapturing Pain Control Dr. Krishna Kumar, M.B., M.S., F.R.C.S. (C), F.A.C.S. Syed Rizvi Sharon Bishop BNurs., MHlthSci.

2 Practice is changing: increasing use of polyanalgesia Which patient groups require monotherapy vs polyanalgesia? When is the introduction of a second agent indicated? The cost implication of polyanalgesia and does it pay off with improved pain control? Objective

3 Study Design 110 patients Mean IDT duration: 94.2 months Chronic Pain: 81 Spasticity : 29 Males: 62 Females: 48 We present a retrospective study of 110 patients receiving IDT for treatment of spasticity and CNMP

4 IDT Drug Regimens Monotherapy: 110 patients 63: monotherapy 51: same drug 12: different drug 47: dual-drug admixture 36: dual-drug admixture 11: triple-drug admixture Avg 500 days Avg 240 days Avg 79 days 43% of patients require polyanalgesia

5 Relationship between IDT & Pain Type Nociceptive Monotherapy (morphine or hydromorphone) Mixed Dual-drug therapy (morphine or hydromorphone) + (bupivacaine or ropivacaine) Neuropathic + spasticity (± myclonus) Triple-drug therapy (fentanyl or hydromorphone) + baclofen + bupivacaine

6 Monotherapy- Morphine # of patients Baseline

7 Dual-admixture dosage escalation eg. Hydromorphone+Bupivacaine Monotherapy # of patients Mean dose per day In most cases, patients are able to reduce narcotic doses and restore effective pain control

8 Baseline Prior to initiating IDT patients were reporting high levels of pain

9 Trends in Polyanalgesia Prescribing trends have changed over time Patients implanted pre-2004 ▫Initiated dual-drug admixture at months (average) ▫Avg. Time Diagnosis  IDT: 6.23 years COMPARED TO Patients implanted post-2004 ▫Initiated dual-drug admixture at 5.38 months (average) ▫Avg. Time Diagnosis  IDT: 4.56 years On average patients implanted post 2004 reported 30% better pain relief at the 5 year mark when compared to those pre 2004.

10 Subgroup Analysis: Pain Relief Monotherapy

11 Oral Analgesia: Post IDT 20 (18%) patients discontinued the usage of oral narcotics The remainder of patients used low dose oral narcotics daily to manage breakthrough pain: Typical: hydromorphone 4-7 mg BID Morphine IR 10 mg BID

12 hydromorph

13 Comparative Costs Conventional Pharmacotherapy Triple-drug IDT Dual-drug IDT Single-drug IDT At 10 years compared to monotherapy Dual-drug therapy: 27% higher cost Triple-drug therapy: 54% higher cost ARIMA (Autoregressive Intermediate Moving Average) model

14 Conclusion Over the longterm ▫IDT monotherapy is effective in 57% of cases ▫Dual drug admixtures were required in 33% of cases, triple drug admixtures in the remaining 10% ▫Polyanalgesia escalates the average daily cost ( % depending on the drugs used) ▫Polyanalgesia is effective in restoring decay in pain control ▫It appears better results are achieved when polyanalgesia is initiated earlier in treatment planning (30% better pain control at 5yrs)


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