Intrathecal Hydromorphone Therapy via Implanted Pump for Chronic Pain Syndrome

Assessment of Medical Necessity

Currently, only morphine and ziconotide are FDA-approved analgesics for long-term intrathecal infusion, according to the American Society of Clinical Oncology 1
No documentation of a preliminary trial of intraspinal opioid drug administration with a temporary intrathecal/epidural catheter demonstrating at least 50% reduction in pain, as recommended by the American Pain Society 2
No psychological evaluation documentation indicating the patient is a favorable candidate for permanent intrathecal pump implantation, as suggested by the American Academy of Pain Medicine 2

Intrathecal drug delivery should be considered only after failure of systemic opioid therapy with escalating doses, switching opioids or routes of administration, or when side effects increase due to dose escalation, according to the American Society of Clinical Oncology 1

Morphine is the first-line opioid for moderate to severe cancer pain and chronic non-cancer pain when delivered intrathecally, as recommended by the National Comprehensive Cancer Network 3, 4
The oral route should be advocated as first choice for analgesic administration before considering invasive options, according to the European Society for Medical Oncology 5
For patients unable to take oral medications, subcutaneous and rectal routes should be considered before intrathecal delivery, as suggested by the British Medical Journal 3

Decreased opioid consumption: intrathecal delivery requires only 10% of the systemic dose for equivalent analgesia, as reported by the American Society of Clinical Oncology 4