EXAMINATION OF ITS EFFECTIVENESS AGAINST OTHER MEASURES

I reviewed 36 available articles up to date in order to answer the above question. In my presentation I will start by giving background information about chronic pain. I will discuss different types of delivery systems available, their benefits to the patient, as well as disbenefits, and cost.

Chronic pain reduces the quality of life in many patients and restricts their ability to engage in normal daily activities. Although many pain patients may be managed in the long term on oral medications, there is percentage of this population that needs additional or alternative means of treatment. Many side effects of the medications themselves, such as depression, drowsiness, confusion may contribute to the intractable nature of the problem. For the past 18 years, administration of opiates by the spinal route has been one of the palliative treatments available for intractable cancer pain or non-malignant pain, which is resistant to other methods. The goal of the morphine pump is not to deal with the underlying disease but to control the pain symptoms. Intrathecal and epidural administration of narcotics

Less than 5% of cancer patients require invasive approaches for the treatment of cancer pain. However, it is theoretically possible to use these technologies for all chronic pain patients, and the market could be enormous.

In terms of disbenefits, there are problems that can arise after the implantation of a pump. These problems can be broadly categorized into surgical, mechanical and pharmacological. Long term, and immediate follow up are required in regard to infection, CSF leakage, neural damage and perhaps tolerance, dependence and safety aspects; in my literature search I found that two patients have died from overdose.

Thus, in conclusion, further studies comparing chronic systemic treatment to spinal infusion would be necessary. Of interest, the National Standing Group on Health Technology has identified intrathecal pump systems for giving opioids in chronic pain as a NHS research priority in 1995.

The cost of the implantable infusion devices is high. There is also the cost of the operation to implant the system, plus the cost of repeated filling and trouble shooting. It could also mean an outpatient visit at least every three months until the pain resolves. Only one attempt has been made to estimate the likely cost of using pumps for long term pain management and this was a very small case series of

Some common words found in the essay are:
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Approximate Word count = 894
Approximate Pages = 4 (250 words per page double spaced)