A Critical Time for Practice Change in the Pain Treatment Continuum: We Need to Reconsider the Role of Pumps in the Patient Care Algorithm

Abstract

Coffey and his colleagues have provided the readers of Pain Medicine with an interesting and practice changing article regarding the use of intrathecal infusion systems for the treatment of chronic pain [1]. The use of intrathecal therapies are a critical part of the current pain treatment continuum. These devices have been used by many of us in aiding patients suffering from pain so severe that they are dysfunctional and have a very poor quality of life. The safety and efficacy of these implants have been well documented in the peer-reviewed literature [2–4]. In patients at the end of life, we often place our efforts and energies toward the alleviation of pain and the reduction of side effects [5]. Coffey and colleagues' evaluation of intrathecal infusion mortality data makes one ask where our energy should be focused in those with chronic diseases that are not at the end of their journey. I believe it is also time to reconsider where we should place pumps on our treatment algorithm. Algorithms have been very important in intrathecal decision making in the past and have led to a clinical standard for drug selection [6–8]. In a recent publication in Pain Medicine , we collaborated to publish an algorithmic guide on how we should measure and establish criteria for the treatment of pain. We recommended that therapies be safe, appropriate, exhibit fiscal neutrality, and show efficacy (SAFE principals) [9,10]. …