TY - JOUR
KW - Analgesics/administration & dosage
KW - Chronic Pain/drug therapy
KW - Humans
KW - Infusions, Spinal
KW - Morphine/administration & dosage
KW - Pain Management
KW - Patient Selection
KW - Physician's Role
KW - Physicians, Primary Care
KW - Referral and Consultation
KW - omega-Conotoxins/administration & dosage
KW - Chronic Disease
KW - pain
KW - patient education
KW - pharmacology/drug reactions
KW - primary care
AU - Gladstone C. McDowell ii
AU - Joseph Winchell
A1 - 
AB - OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan. METHODS: The Medline database and evidence-based treatment guidelines were searched to identify publications on intrathecal (IT) therapy for the management of chronic pain. Selection of publications relevant to PCPs was based on the authors' clinical and research expertise. RESULTS: IT administration delivers analgesic medication directly into the cerebrospinal fluid, avoiding first-pass effect and bypassing the blood-brain barrier, thereby requiring lower medication doses. Morphine, a micro-opioid receptor agonist, and ziconotide, a non-opioid, selective N-type calcium channel blocker, are the only analgesics approved by the US Food and Drug Administration to treat chronic refractory pain by the IT route. Patients who are potential candidates for IT therapy may benefit from evaluation by an interventional pain physician. PCPs can play an important role in patient selection and referral for IT therapy and provide ongoing collaborative care for patients receiving IT therapy, including monitoring for efficacy and adverse events and facilitating communication with the treating specialist. CONCLUSIONS: Collaboration between PCPs and pain specialists may improve outcomes of and patient satisfaction with IT therapy and other interventional treatments.
AD - a Integrated Pain Solutions , Columbus , OH , USA.; b Mount Carmel Health Systems , Columbus , OH , USA.
BT - Postgraduate medicine
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 4
CY - England
DO - 10.1080/00325481.2018.1448207
IS - 4
JF - Postgraduate medicine
LA - eng
M1 - Journal Article
N2 - OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan. METHODS: The Medline database and evidence-based treatment guidelines were searched to identify publications on intrathecal (IT) therapy for the management of chronic pain. Selection of publications relevant to PCPs was based on the authors' clinical and research expertise. RESULTS: IT administration delivers analgesic medication directly into the cerebrospinal fluid, avoiding first-pass effect and bypassing the blood-brain barrier, thereby requiring lower medication doses. Morphine, a micro-opioid receptor agonist, and ziconotide, a non-opioid, selective N-type calcium channel blocker, are the only analgesics approved by the US Food and Drug Administration to treat chronic refractory pain by the IT route. Patients who are potential candidates for IT therapy may benefit from evaluation by an interventional pain physician. PCPs can play an important role in patient selection and referral for IT therapy and provide ongoing collaborative care for patients receiving IT therapy, including monitoring for efficacy and adverse events and facilitating communication with the treating specialist. CONCLUSIONS: Collaboration between PCPs and pain specialists may improve outcomes of and patient satisfaction with IT therapy and other interventional treatments.
PP - England
PY - 2018
SN - 1941-9260; 0032-5481
SP - 411
EP - 419
EP - 
T1 - Role of primary care physicians in intrathecal pain management: a narrative review of the literature
T2 - Postgraduate medicine
TI - Role of primary care physicians in intrathecal pain management: a narrative review of the literature
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 29542370
U3 - 10.1080/00325481.2018.1448207
VL - 130
VO - 1941-9260; 0032-5481
Y1 - 2018
Y2 - May
ER -