The risks of ITDD is: Loss of power Loss of bladder and bowel sensation Discrete areas of loss of skin sensation that can lead to pressure sores. Referral for ITDD is from existing palliative care patients for whom pain is uncontrolled despite best practice and/or there is untolerabel side effects form current meds. This is followed by multidisciplinary assessment where psychological assessment is important. The patient is then provided information and a further MDT discussion is held. Dr Gordon McGinn Chronic Pain Consultant to the GGC Cancer Service – Dr McGinn talked initially the different types of pumps used in ITDD and reported that his service uses the Archimedes. They have audited and evaluated the patients fitted with internal pumps since 2007. The average number of internal ITTD pumps per year is 5. Since 2007 21 patients have had ITDD pumps. 3/21 patients were unable to continue with their pumps due to CSF leak, unable to refill the pumps (with opiate and anaesthetic) or unable to be supported in the community. 16/21 patients used their pumps until death. Physio assessment is completed before and after insertion of pump. The assessment covers pain VAS for sitting, standing and walking, mobility, RoM and power, and the Brief Pain Inventory. Before insertion of pump the average functional pain VAS is 5/10, after pump is fitted it is down to 1/10. Brief Pain Inventory pre is 9/10 and post is 4/10. Pre ITTD mean morphine intake is 1168 mg Post ITTD mean morphine intake is down to 31mg!! Mean length of time with ITTD ranges from 10 days to 292 days. Dr McGinn mentioned at this point that patients need to be fit enough to undergo the procedures required for fitting. Place of death data: 6/16 at home and 3/16 in the cancer centre.
The risks of ITDD is: Loss of power Loss of bladder and bowel sensation Discrete areas of loss of skin sensation that can lead to pressure sores. Referral for ITDD is from existing palliative care patients for whom pain is uncontrolled despite best practice and/or there is untolerabel side effects form current meds. This is followed by multidisciplinary assessment where psychological assessment is important. The patient is then provided information and a further MDT discussion is held. Dr Gordon McGinn – Chronic Pain Consultant to the GGC Cancer Service Dr McGinn talked initially the different types of pumps used in ITDD and reported that his service uses the Archimedes. They have audited and evaluated the patients fitted with internal pumps since 2007. The average number of internal ITTD pumps per year is 5. Since 2007 21 patients have had ITDD pumps. 3/21 patients were unable to continue with their pumps due to CSF leak, unable to refill the pumps (with opiate and anaesthetic) or unable to be supported in the community. 16/21 patients used their pumps until death. Physio assessment is completed before and after insertion of pump. The assessment covers pain VAS for sitting, standing and walking, mobility, RoM and power, and the Brief Pain Inventory. Before insertion of pump the average functional pain VAS is 5/10, after pump is fitted it is down to 1/10. Brief Pain Inventory pre is 9/10 and post is 4/10. Pre ITTD mean morphine intake is 1168 mg Post ITTD mean morphine intake is down to 31mg!! Mean length of time with ITTD ranges from 10 days to 292 days. Dr McGinn mentioned at this point that patients need to be fit enough to undergo the procedures required for fitting. Place of death data: 6/16 at home and 3/16 in the cancer centre.
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