1. 2013;16;SE185-SE216Intrathecal Infusion Systems for Long-Term Management of Chronic Non-Cancer Pain: An Update of Assessment of Evidence
   Systematic Review
   Frank J.E. Falco, MD, Vikram B. Patel, MD, Salim M. Hayek, MD, PhD, Timothy R. Deer, MD, Stephanie Geffert, MLIS, Jie Zhu, MD, Obi Onyewu, MD, Sareta Coubarous, DO, Howard S. Smith, MD, and Laxmaiah Manchikanti, MD.

BACKGROUND: Intrathecal infusion systems are often used for patients with intractable pain when all else fails, including surgery. There is, however, some concern as to the effectiveness and safety of this treatment.

STUDY DESIGN:  A systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain.

OBJECTIVE: To evaluate and update the effect of intrathecal infusion systems in managing chronic non-cancer pain.

METHODS: The available literature on intrathecal infusion systems in managing chronic pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2012, and manual searches of the bibliographies of known primary and review articles.

OUTCOME MEASURES: The primary outcome measure was pain relief with short-term relief < 12 months and long-term relief = 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.

RESULTS: There were 28 studies identified for this systematic review. Of these, 21 were excluded from further review. A total of 7 non-randomized studies met inclusion criteria for methodological quality assessment. No randomized trials met the inclusion requirements.
The evidence is limited based on observational studies.

LIMITATIONS: The limitations of this systematic review include the paucity of literature.

CONCLUSION: The evidence is limited for intrathecal infusion systems.