Disclosures: Jasmina Solankee, MD: No financial relationships or conflicts of interest

Objective: 1) To determine how implantation and management of intrathecal (IT) pain pumps changes the use of prescribed oral opioids in patients with chronic pain or spasticity. 2) To examine changes in utilization of oral benzodiazepines in patients with IT pumps.

Design: Retrospective chart review of current prescribed medications as well as active outpatient prescriptions at the time of IT pump implantation.Setting : University-associated Physical Medicine & Rehabilitation ClinicParticipants : Chronic pain patients who have undergone surgical implantation trial and had continued management of their IT pumps by clinicians at the home institution.

Interventions: Not applicable.

Main Outcome Measures: Demographic and medication-related outcome data were collected through EMR review. Main outcome measures include the changes in prescribed oral opioids, as measured by daily total allowed morphine milligram equivalents (MME), and benzodiazepines.

Results: IT pump implantation duration ranged from 1.5 – 11 years. 31 (97%) patients had a decrease in oral opioid prescriptions from the time of implantation to the present. Among these patients, there was an average decrease in daily MME of 83.8%. 11 (34.4%) patients have been completely weaned off oral opioids. 76.5% of the participants with oral benzodiazepine use prior to pump placement had decreased current benzodiazepine utilization. While 5 (24.9%) patients were weaned off benzodiazepines, 7 (21.7%) patients with no prior prescriptions did have current use.Conclusions: Pain pumps relieve pain by directly infusing medications, at significantly lower doses compared to oral administration, into the intrathecal space. Our results show that implantation leads to substantial reductions in the utilization of oral opioids in chronic pain patients. The unclear change in benzodiazepine utilization may be complicated by psychiatrist prescribed benzodiazepines for other diagnoses. These results inform future management options for chronic pain in patients who are at increased risk for developing dependence on oral opioid medications.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/examining-the-utilization-of-oral-opioids-and-benzodiazepines-after-implantation-of-intrathecal-pain-pumps/