{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:07:37Z","timestamp":1788883657436,"version":"build-2803163510"},"reference-count":43,"publisher":"BMJ","issue":"9","funder":[{"name":"National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health","award":["UM1TR004528"],"award-info":[{"award-number":["UM1TR004528"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intrathecal drug delivery (IDD) is often used in the management of refractory chronic non-cancer pain, particularly persistent chronic low back pain in the setting of previous lumbar spine surgery (persistent spinal pain syndrome type 2 (PSPS2)). Complications of IDD leading to device explant in patients with chronic non-cancer pain have not been well characterized. This study evaluated complications leading to device explants in a large cohort of patients with chronic non-cancer pain treated with IDD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study was undertaken on patients with chronic non-cancer pain who underwent device implants by Pain Medicine physicians between June 2009 and December 2022 at a large tertiary center academic practice. Data collection included demographic and comorbidity data as well as the various indications for device explant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were collected from 215 patients with chronic non-cancer pain who underwent device implant and were followed for a mean duration of 80\u00b148.8 months. The average age at the time of implant was 63.24\u00b112.05 years, and the majority (184 patients) suffered from PSPS2. The explant rate was 26.1%, and device-related infection was the leading cause of explants occurring in 9.3% of patients and 5.9% of device surgeries. Loss of analgesic efficacy leading to device explant occurred in 5.6% of patients, but this was significantly less than the explant rate due to habituation noted with spinal cord stimulation (SCS) in a similar patient population. compared with other complications leading to device explants, infections had a much earlier time interval from device implant to explant. No demographic or comorbidity factors correlated with device explants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Device-related infections are the leading cause for explants in IDD for chronic non-cancer pain. Explants due to loss of analgesic efficacy occurred at a lesser frequency with IDD compared with SCS explants in a similar patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107223","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:23:17Z","timestamp":1788880997000},"page":"1048-1054","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Complications leading to device explant in patients with chronic non-cancer pain receiving intrathecal drug delivery"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7936-017X","authenticated-orcid":false,"given":"Salim Michel","family":"Hayek","sequence":"first","affiliation":[{"name":"Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"},{"name":"Case Western Reserve University Hospital, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameam","family":"Shahrestani","sequence":"additional","affiliation":[{"name":"Case Western Reserve University Hospital, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Blank","sequence":"additional","affiliation":[{"name":"Case Western Reserve University Hospital, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Feijo","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Reyes","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phu","family":"Duong","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muskan","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuchen","family":"Li","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Shaner","sequence":"additional","affiliation":[{"name":"Northeast Ohio Medical University, Rootstown, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Murphy","sequence":"additional","affiliation":[{"name":"Case Western Reserve University Hospital, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9123-136X","authenticated-orcid":false,"given":"Michael D","family":"Staudt","sequence":"additional","affiliation":[{"name":"Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090808100908000_51.9.1048.1","doi-asserted-by":"crossref","unstructured":"Lucas J , Sohi I . 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