{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:11:33Z","timestamp":1788923493838,"version":"build-2803163510"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background. Intrathecal (IT) pumps have become a valuable tool in managing intractable non-cancer pain. The purpose of this study was to evaluate the efficacy of using a rigorous treatment algorithm for trialing and implanting IT pumps with hydromorphone and bupivacaine in managing a more homogeneous population of post-laminectomy syndrome or failed back surgery syndrome (FBSS) patients.<\/jats:p>\n                  <jats:p>Methods.\u00a0This is a retrospective analysis of FBSS patients with chronic intractable back pain implanted with IT pumps delivering hydromorphone and bupivacaine.<\/jats:p>\n                  <jats:p>Results.\u00a0A cohort of 57 (26 males, 31 females) consecutively implanted FBSS patients was analyzed. The average age at implant was 65.4 years. Average pain scores were 8.4\u2009\u00b1\u20090.2 (pre-implant), 4.9\u2009\u00b1\u20090.4 (6 months), 5.2\u2009\u00b1\u20090.5 (12 months), and 4.3\u2009\u00b1\u20090.5 (24 months). Average oral opioid doses in morphine equivalents were 56\u2009\u00b1\u200910 mg\/day (pre-implant), 12.0\u2009\u00b1\u20093.5 mg\/day (12 months), 15\u2009\u00b1\u20096 mg\/day (24 months). Average IT hydromorphone doses were 79\u2009\u00b1\u20096.8 mcg\/day (at implant), 184\u2009\u00b1\u200922 mcg\/day (6 months), 329\u2009\u00b1\u200948 mcg\/day (12 months), and 487\u2009\u00b1\u200980 mcg (24 months). IT hydromorphone dose escalation from baseline was 133% (6 months vs baseline), 78% (12 months vs 6 months), and 48% from 12 months to 24 months. Average IT bupivacaine doses were 5.8\u2009\u00b1\u20090.3 mg\/day (implant), 9.5\u2009\u00b1\u20090.6 mg\/day (6 months), 12.2\u2009\u00b1\u20090.7 mg\/day (12 months), and 12.6\u2009\u00b1\u20090.9 mg\/day (24 months).<\/jats:p>\n                  <jats:p>Conclusion.\u00a0IT hydromorphone and bupivacaine are effective in treating chronic pain of FBSS, as demonstrated by the reduction of pain intensity and oral opioid consumption. However, an IT dose escalation phenomenon was observed, although at a reduced rate compared with what had been previously reported in the literature. It is possible that the local anesthetic combination delivered via a patient-activaed bolus device is an important factor. Despite demonstrating effectiveness, the clinical utility of myPTM-optimized IT therapy remains limited by a lack of prospective, placebo-controlled trials and comparative effectiveness research.<\/jats:p>","DOI":"10.1093\/pm\/pnv021","type":"journal-article","created":{"date-parts":[[2016,1,19]],"date-time":"2016-01-19T16:07:10Z","timestamp":1453219630000},"page":"561-571","source":"Crossref","is-referenced-by-count":12,"title":["Intrathecal Hydromorphone and Bupivacaine Combination Therapy for Post-Laminectomy Syndrome Optimized with Patient-Activated Bolus Device"],"prefix":"10.1093","volume":"17","author":[{"given":"Salim M.","family":"Hayek","sequence":"first","affiliation":[{"name":"**Department of Anesthesiology, Division of Pain Medicine, University Hospitals Case Medical Center, Cleveland, Ohio"},{"name":"\u2020Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Veizi","sequence":"additional","affiliation":[{"name":"\u2020Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio"},{"name":"\u2021Department of Anesthesiology, Pain Medicine and Spine Care, Louis Stokes Veterans Administration Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hanes","sequence":"additional","affiliation":[{"name":"**Department of Anesthesiology, Division of Pain Medicine, University Hospitals Case Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,12,14]]},"reference":[{"key":"2025112800314889400_pnv021-B1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.36076\/ppj.2011\/14\/219","article-title":"Intrathecal therapy for cancer and non-cancer pain","volume":"14","author":"Hayek","year":"2011","journal-title":"Pain Physician"},{"key":"2025112800314889400_pnv021-B2","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s11916-013-0388-x","article-title":"Intrathecal therapy for chronic pain: Current trends and future needs","volume":"18","author":"Hayek","year":"2014","journal-title":"Curr Pain Headache Rep"},{"key":"2025112800314889400_pnv021-B3","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/papr.12111","article-title":"Intrathecal drug administration in chronic pain syndromes","volume":"14","author":"Ver Donck","year":"2014","journal-title":"Pain Pract"},{"key":"2025112800314889400_pnv021-B4","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/S0885-3924(00)00202-5","article-title":"Clinical guidelines for intraspinal infusion: Report of an expert panel. 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