{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:06:53Z","timestamp":1788923213837,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,6,27]],"date-time":"2013-06-27T00:00:00Z","timestamp":1372291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intrathecal drug delivery (<jats:styled-content style=\"fixed-case\">IDD<\/jats:styled-content>) system with implantable pumps has been used to treat cancer\u2010related pain as well as noncancer\u2010related chronic pain. Opioids, including morphine and hydromorphone, are the most commonly used intrathecal (<jats:styled-content style=\"fixed-case\">IT<\/jats:styled-content>) agents. Although technology, techniques, and knowledge of <jats:styled-content style=\"fixed-case\">IDD<\/jats:styled-content> have improved, dose escalation occurs relatively rapidly in noncancer pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective chart review of <jats:styled-content style=\"fixed-case\">IDD<\/jats:styled-content> pump patients, implanted for a minimum of 2\u00a0years, was designed to investigate possible existing predictors that might impact <jats:styled-content style=\"fixed-case\">IDD<\/jats:styled-content> dose escalation, such as patient's demographic risk factors, duration of the treatment, and diagnosis of the patient's pain correlates with increase in medication requirement. Primary outcome was defined as the annual percent escalation in daily opioid dosage, and secondary outcome was the average annual percent reduction in <jats:styled-content style=\"fixed-case\">VRS<\/jats:styled-content> pain scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median dosage escalation was 17% per year for patients with neuropathic pain compared with 12% per year for patients with other pain modalities. Mean opioid dosage increased 30.4% more rapidly for patients with neuropathic pain than for other pain modalities. The adjusted difference in means was 28.8% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001). None of the secondary exposures were statistically significant after the <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>onferroni adjustment. No association was found between pain modality and annual percent change in <jats:styled-content style=\"fixed-case\">VRS<\/jats:styled-content> pain score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Annual increases in daily opioid dosage were higher among patients with neuropathic pain than among patients with other modalities; we also found no evidence of difference in annual pain reduction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12096","type":"journal-article","created":{"date-parts":[[2013,6,27]],"date-time":"2013-06-27T07:17:03Z","timestamp":1372317423000},"page":"301-308","source":"Crossref","is-referenced-by-count":22,"title":["Factors That Might Impact Intrathecal Drug Delivery (<scp>IDD<\/scp>) Dose Escalation: A Longitudinal Study"],"prefix":"10.1111","volume":"14","author":[{"given":"Nagy","family":"Mekhail","sequence":"first","affiliation":[{"name":"Evidence\u2010Based Pain Management Research Cleveland Clinic Cleveland Ohio U.S.A."},{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramatia","family":"Mahboobi","sequence":"additional","affiliation":[{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Farajzadeh Deroee","sequence":"additional","affiliation":[{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shrif","family":"Costandi","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Pain Management Research Cleveland Clinic Cleveland Ohio U.S.A."},{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrod","family":"Dalton","sequence":"additional","affiliation":[{"name":"Department of Outcomes Research Cleveland Clinic Cleveland Ohio U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maged","family":"Guirguis","sequence":"additional","affiliation":[{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Pain Management Cleveland Clinic Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,6,27]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","first-page":"43","article-title":"Intrathecal opioids for intractable pain syndromes","volume":"97","author":"Koulousakis A","year":"2007","journal-title":"Acta Neurochir Suppl"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.36076\/ppj.2010\/13\/E175","article-title":"Consensus guidelines for the selection and implantation of patients with noncancer pain for intrathecal drug delivery","volume":"13","author":"Deer TR","year":"2010","journal-title":"Pain Physician"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000152191.29311.9B"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1067\/S1526-5900(03)00730-2"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01232.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpneuro0113"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2009.0649"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200927020-00002"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2174\/187152412803760645"},{"key":"e_1_2_8_11_1","first-page":"593","volume-title":"Interventional Pain Management","author":"Krames ES","year":"2001"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-2-200701160-00006"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2006.10.029"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042580"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200603000-00025"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1586\/ern.10.37"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198409000-00008"},{"key":"e_1_2_8_18_1","first-page":"49","article-title":"Tolerance to opioid analgesics: clinical aspects","volume":"21","author":"Portenoy RK","year":"1994","journal-title":"Cancer Surv"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/bean.2002.0255"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/eujp.2001.0255"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2010.00876.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(01)00353-6"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(95)00099-2"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(96)00010-3"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200208000-00037"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/104990910402100214"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpapr.12096","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.12096","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T08:43:36Z","timestamp":1696495416000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.12096"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,6,27]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,4]]}},"alternative-id":["10.1111\/papr.12096"],"URL":"https:\/\/doi.org\/10.1111\/papr.12096","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,6,27]]}}}