Authors' objectives:

To assess the safety and efficacy of implantable spinal infusion devices for treating chronic pain and spasticity.

Authors' results and conclusions: The use of implantable spinal infusion devices appears safe. Drug related adverse events do occur, as they do when chronically administered via the systemic route, although perhaps less than for systemic administration. Device related adverse events occur with replacement or revision rates ranging from 3 to 17% and the explantation rate varying from 0 to 21% in the reviewed literature. Infusion of drugs via implantable spinal infusion devices appears efficacious, with significant reductions in pain measured via visual analogue scales for pain. Improvements in care and activities of daily living were reported for patients with spasticity. The included randomized controlled trial also showed a reduction in toxicity, when compared to medical management, and this reduction in toxicity impacted on the cumulative survival of the group implanted with the spinal infusion device. Cost studies showed that implantable spinal infusion devices are less costly, in the long-term, than medical management. Short-term costs of implantable infusion devices are high, due to the cost of screening, the device itself and implantation of the device. Implantable infusion devices were not cost-effective when circumstances of high adverse events and high cost of care were simulated. Therefore it is important to carefully select a patient group who are suitable for implantation and are likely to retain the implant.

Authors' recommendations: Infusion of opioid agents for treatment of chronic pain or baclofen for treatment of spasticity, intrathecally via implantable infusion devices appears safe and effective, although this conclusion is based on limited evidence.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/systematic_review/Spinalinfusionaccelr eview0503.pdf

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical